False Claims Act Litigation & Investigations
Companies that do business with the government rely on our FCA team to resolve their unique litigation and compliance challenges.
“They have an excellent healthcare practice and they’re significant in False Claims Act investigations in that area.”—Client Testimonial, Chambers USA
Companies that do business with the government rely on our FCA team to resolve their unique litigation and compliance challenges.
“They have an excellent healthcare practice and they’re significant in False Claims Act investigations in that area.”—Client Testimonial, Chambers USA
With a team that includes former senior fraud prosecutors and career white collar defense attorneys, our False Claims Act group helps clients resolve the unique challenges posed by government enforcers and incentivized litigants. Our work has led the Department of Justice to decline and, in some cases, dismiss relators’ FCA cases. We have also resolved state and federal government investigations with favorable outcomes before they became public. And in cases that have gone to court, we’ve won significant victories for FCA defendants.
As the United States’ chief civil enforcement tool for investigating and pursuing alleged fraud against the government, the FCA can expose companies to enormous financial risk. Each year, DOJ seeks and obtains billions of dollars in FCA settlements and judgments. Over the last decade, it has taken in more than US$37 billion from FCA defendants.
Many FCA actions originate as sealed qui tam complaints brought by private litigants with purported knowledge of alleged fraud—and with financial incentives to plead FCA claims. Hundreds are filed every year, triggering DOJ investigations. As DOJ and relators’ counsel continue their aggressive pursuit of potential fraud claims, any entity or person that does business, directly or indirectly, with the US government—or invests in companies that do government business—must understand and protect against FCA liability risk.
Services
- Government Investigations and Enforcement. We advise companies, individual officers and directors, and other executives in investigations by DOJ, various federal Offices of Inspector General, State Attorneys General, and other regulators over alleged FCA violations. We also litigate actions in which DOJ is our clients’ direct adversary, including DOJ-initiated FCA suits and qui tam suits in which DOJ has intervened.
- Civil Qui Tam Litigation. In cases where the government declines to intervene and a qui tam relator pursues an FCA action to litigation, we have a long record of securing dismissals and successful settlements.
- Internal Investigations. When concerns about potential violations arise, our interdisciplinary team guides companies, boards, and audit committees through highly sensitive internal investigations, which we conduct to help clients assess FCA allegations and implement preventative measures. When regulators are involved, we actively advance the company’s interests while managing potential risk areas in related ancillary litigation.
- Parallel Proceedings. FCA suits are often accompanied by other litigation or government investigations, particularly where the allegations involve newsworthy or controversial topics. Our team has extensive experience coordinating complex FCA matters alongside parallel proceedings such as shareholder suits, SEC enforcement matters, class actions, and congressional investigations, and we routinely counsel clients about navigating their defenses in parallel proceedings. And because many FCA actions originate through complaints by employee insiders, we regularly coordinate with O’Melveny’s Labor & Employment team to defend our clients against related retaliation claims.
Areas of Expertise
- Anti-Kickback Statute
- Customs Duties
- Cybersecurity and Data Privacy
- Defective Pricing
- Defense Contracts
- Federally Insured Mortgages
- Medicaid
- Medicare Advantage
- Medicare Secondary Payer
- Pharmaceutical and Medical Device Marketing
- SBA/CARES Act
- Stark Law
Defending Anthem in an FCA investigation and subsequent litigation involving allegations that its Medicare Advantage business improperly retained payments based on potentially invalid diagnosis data in connection with its chart review practices. United States v. Anthem, Inc., No. 20-cv-02593 (S.D.N.Y.).
Defended a major bank and a large mortgage servicing company against FCA lawsuits alleging that they falsely certified compliance with Home Affordable Modification Program requirements. O’Melveny successfully negotiated settlements of each of these suits at a small fraction of the alleged damages.
Winning a significant victory on behalf of Humana in a relator’s appeal to the Eleventh Circuit, which affirmed the district court’s dismissal of the lawsuit with prejudice. The case represents an important holding for defendants in the FCA’s public disclosure bar jurisprudence. U.S. ex rel. Osheroff v. Humana, 776 F.3d 805 (11th Cir. 2015).
Representing Humana in ongoing litigation defending against FCA allegations related to the Medicare Part D bid process. U.S. ex rel. Scott v. Humana, No. 3:18-cv-00061 (W.D. Ky.).
Defending Kaiser Permanente entities against FCA allegations related to medical record documentation and coding standards in the Medicare Advantage program. U.S. ex rel. Osinek et al v. Kaiser Permanente, No. 13-cv-03891 (N.D. Cal.).
Defending a health plan against FCA allegations that a vendor failed to comply with Medicare Advantage diagnosis data submission standards, causing the defendant to submit incorrect data to the government. O’Melveny helped the defendant reach a favorable settlement with DOJ. U.S. es rel. Ross v. Group Health Cooperative, No. 12-cv-0299S (W.D.N.Y).
Representing a large medical-device manufacturer in connection with a DOJ investigation into two FCA complaints predicated on alleged violations of the Anti-Kickback Statute.
Representing a large transportation industry client in an FCA investigation into allegedly inflated rates charged to a government agency.
Representing a major defense contractor in connection with a DOJ investigation into FCA allegations related to alleged labor mischarging under government contracts.
Defending a major national insurance company in connection with an FCA investigation by DOJ and HHS-OIG and subsequent litigation of an unsealed qui tam complaint alleging that the company failed to comply with Medicare Advantage diagnosis data submission requirements. O’Melveny won dismissal of several of the relator’s claims, leading to a successful settlement on the remaining claims. U.S. ex rel. Graves v. Plaza Medical Centers, No. 1:10-cv-23382 (S.D. Fla.).
Defending a major national insurance company in connection with an FCA investigation by DOJ and HHS-OIG and subsequent litigation of an unsealed qui tam complaint alleging that the company failed to comply with Medicare Advantage diagnosis data submission requirements. O’Melveny won dismissal of several of the relator’s claims, leading to a successful settlement on the remaining claims. U.S. ex rel. Graves v. Plaza Medical Centers, No. 1:10-cv-23382 (S.D. Fla.).
Defending major national managed care organizations against FCA allegations relating to compliance with Medicare Advantage regulations, including allegations related to inflated premiums resulting from chart review practices of contracted providers and in-home assessment vendors. O’Melveny has achieved dismissals of two clients from such matters, and secured a favorable settlement with DOJ in another matter. U.S. ex rel. Swoben v. SCAN Health Plan, No. 2:09-cv-05013 (C.D. Cal.); U.S. ex rel. Ramsey-Ledesma v. Censeo Health, LLC, No. 3:14:000118 (N.D. Tex.); U.S. ex rel. Silingo v. Mobile Medical Examination Servs., Inc., No. 8:13-cv-01348 (C.D. Cal.).
Counseling a leading medical-device manufacturer through parallel DOJ civil and criminal investigations of a qui tam complaint alleging a kickback scheme for reimbursement of defective devices in violation of the FCA.
Representing numerous Medicare Advantage Organizations in responding to civil investigative demands issued by DOJ in FCA investigations related to Medicare risk adjustment, Medicare Part D, the Anti-Kickback Statute, and other federal healthcare laws and regulations.
Representing a pharmacy benefits manager in a DOJ investigation of a qui tam complaint alleging our client and others in the industry pressured pharmaceutical companies to keep prices high in exchange for rebates and increased fees at the government’s expense. O’Melveny’s advocacy in this matter resulted in a declination for our client.
Representing a vitamin and supplement manufacturer and distributor in response to allegations that false claims were submitted in filings with Customs and Border Protection related to the import of goods into the United States.