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Category: Insurance Coverage

7th Circuit / Enforcement / False Statement / Healthcare / Insurance Coverage / Overpayments / Pleading Standards

14 Mar, 2019

Another Qui Tam Suit Alleging a Scheme to Defraud by Reporting Inflated Drug Prices Survives Motion to Dismiss

Within the last five years, district courts in the Seventh Circuit have repeatedly denied motions to dismiss qui tam lawsuits brought under the FCA that allege a scheme to defraud government health programs by reporting inflated “usual and customary” prices for prescription drugs. By contrast, at least one district court in the Sixth Circuit recently granted such a motion under Rule 9(b). On March 7,...

Enforcement / Healthcare / Implied Certification / Insurance Coverage

14 Feb, 2019

DOJ Levels False Claims Act at Pharmacies to Combat Opioid Crisis

This month the Department of Justice brought a “first of its kind” action against two pharmacies, their owner, and three pharmacists for allegedly dispensing and billing Medicare for prescriptions in violation of both the Controlled Substances Act (CSA) and the False Claims Act (FCA).  See United States v. Oakley Pharmacy, Inc., et al., No. 2:19-cv-00009 (M.D. Tenn).  The action, seeking both injunctive relief and civil...

Insurance Coverage

9 Sep, 2015

Fifth Circuit Concludes That FCA Claim Was Not Covered By Insurance Policy

The U.S. Court of Appeals for the Fifth Circuit recently rejected a shipbuilder’s claim against its insurance company seeking defense and indemnification from a False Claims Act suit. See XL Spec. Ins. Co. v. Bollinger Shipyards, Inc., No. 14-31283, 2015 WL 5052504, 2015 U.S. App. LEXIS 15160 (5th Cir. Aug. 27, 2015). Over a decade ago, shipbuilder Bollinger Shipyards, Inc. retrofitted patrol boats under contract...