Acronyms
Formerly called the Health Care Financing Administration, this federal agency receives millions of claims per day dealing with government funded health insurance.
What is CMS? (Centers for Medicare and Medicaid Services)
This President, tired of unscrupulous defense contractors taking advantage of the government, came up with the idea for the law, to encourage insiders to come forward.
Who is Lincoln?
A criminal statute, this law seeks to prevent money or other "things of value" from interfering with physician's judgment.
What is the Anti-Kickback Statute (42 USC ยง 1320a-7b(b))?
When an FCA case gets litigated, defense lawyers often file a motion to dismiss for failure to plead fraud with particularity, invoking this Civil Rule.
What is Fed R. Civ. Procedure 9(b)?
This "evidentiary roadmap," unlike the FCA complaint, does not get filed with the court but only served on the government.
What is a Disclosure Statement?
This federal department overseas the work of the FBI and the US Attorney's Offices in most health care investigations, particularly those involving the False Claims Act.
What is DOJ? (Department of Justice)
The statute provides for a trebling of the government's actual damages, but these allow for the government to recover additional monies on a per claim basis.
What are penalties?
You have to have your reading glasses on to get through these laws, which are civil only, and regulate physician self-referral scenarios.
What is Stark I and II?
This bar is often the basis for a motion to dismiss, if another party to the suit feels that some other relator has beaten you to the punch.
What is the "first to file bar?"
If you forget to include these counts in a Medicaid case, your whistleblower client may get short-changed come payday.
What are state claims?
This investigative tool is found in the False Claims Act, giving prosecutors more options for investigating civil claims without using a criminal grand jury.
What is a CID? (Civil Investigative Demand)
Since the statute was amended in this year, FCA recoveries have been going steadily up.
What is 1986?
Some corporate entities and executives have recently found themselves charged with this criminal violation, initially created for organized crime/mob prosecutions.
What is RICO?
This bar can have relator's counsel scanning public records before filing, or seeing if the client has enough original information to get around it.
What is the public disclosure bar?
To protect her client's "original source" status, counsel for relator better serve one of these on the government.
What is a "pre-filing disclosure?"
This federal agency often authors guidance to regulated health care industries about what's legal and what's not, promulgates regulations and even authors "advisory opinions."
What is HHS/Office of Inspector General (OIG)?
If the relator is first to file and not otherwise disqualified or limited in his/her recovery, he or she stands to gain what at the conclusion of the case?
What is 15-30% of the government's recovery depending on whether the government intervenes?
Arising out of the Food Drug and Cosmetic Act, this is one of the few scenarios in which the criminal law dispenses with the usual intent requirement.
What is the "responsible corporate officer doctrine?"
Popular in defense of off-label prosecutions, this theory invokes a cherished constitutional right.
What is free speech / First Amendment?
To keep tabs on what the prosecution is up to, and to maximize the scope of the attorney-client privilege, defense lawyers often use these agreements.
What is a "joint defense" or "common interest" agreement?
This loose association coordinates the responses of the state attorney general's offices to national qui tam claims filed by whistleblowers.
What is NAMFCU? (National Association of Medicaid Fraud Control Units)
An action is not barred if it is brought within this time period of the offense being committed.
What is six years or three years after the responsible government official learns of the fraud, but no later than ten years?
What you say about a drug in your marketing materials, on your website, or even in verbal presentations can have you running afoul of this FDCA prohibition.
What is misbranding?
These remedies are what make settlement negotiations between the government and companies a big game of chicken: one can't fully defend against it; the other may not be willing to pull the trigger.
What is exclusion and debarment?
Hoping to get information while the subject company doesn't yet know it's under investigation, prosecutors will often talk to these people first, after they interview the relator.
Who are former employees?