Profit Seeking Is Not Fraudulent
Client Alert | less than 1 min read | 10.12.12
In United States ex rel. Williams v. Renal Care Group, Inc., the Sixth Circuit found the defendants did not knowingly submit false claims to Medicare when they followed industry practices and sought guidance -- both from outside legal counsel and the government -- on how to follow ambiguous federal regulations, even though the contractors sought to maximize government payments. The court dismissed the idea that contractors "ought to be punished solely for seeking to maximize profits" and rejected the government's argument that the companies had "recklessly" misinterpreted the regulations to do so.
Insights
Client Alert | 8 min read | 03.05.26
A recent decision by the United States Court of Appeals for the Fifth Circuit, Farmers Texas County Mutual Insurance Co. v. 1st Choice Accident & Injury, LLC, No. 24-20275 (5th Cir. Feb. 24, 2026), offers important lessons for health care payors and other potential plaintiffs considering civil claims under the federal Racketeer Influenced and Corrupt Organizations Act (RICO). Although the Fifth Circuit’s decision focused on a procedural issue, the underlying case turned on a fundamental pleading failure: the plaintiff insurers did not adequately describe the fraudulent network they were suing as a RICO “enterprise.” The result was dismissal of a $14 million fraud case.
Client Alert | 4 min read | 03.04.26
Sixth Circuit Finds EFAA Arbitration Bar to Entire Case — Not Just Sexual Harassment Claims
Client Alert | 3 min read | 03.02.26
Client Alert | 4 min read | 03.02.26
