On February 22, 2021, the United States Supreme Court declined to review two False Claims Act (FCA) cases, solidifying a split that pits the Eleventh Circuit against the Third and Ninth Circuits as to whether a disagreement...more
As COVID-19 continues to ravage the United States, the Department of Justice (DOJ) has recently announced its new National Rapid Response Strike Force within the Health Care Fraud Unit to investigate and prosecute fraud cases...more
10/2/2020
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Criminal Investigations ,
Department of Justice (DOJ) ,
DOJ Strike Force ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Infectious Diseases ,
Paycheck Protection Program (PPP) ,
Pharmaceutical Industry ,
Physicians ,
Stark Law
On Thursday, AseraCare, a national hospice care provider, announced that it had settled a long-standing Medicare billing dispute with the DOJ, a case that has garnered nationwide attention in healthcare since 2008. At issue...more
3/5/2020
/ Department of Justice (DOJ) ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Hospice ,
Medicare ,
Medicare Billing Privileges ,
Settlement Agreements ,
Statistical Sampling
In a one-two punch during the first half of September 2019, the Department of Justice confirmed that its focus on prosecuting telemedicine companies and physicians engaged in health care fraud shows no sign of slowing...more
9/24/2019
/ Criminal Conspiracy ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Guilty Pleas ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Physicians ,
Telemedicine
Since the Department of Justice filed charges in April 2019 against 24 telemedicine and durable medical equipment (“DME”) company executives and physicians for their alleged participation in a $1.2 billion healthcare fraud...more
Telemedicine permits two-way, real time interactive communication between health professionals and patients. Its recent expansion has dramatically improved patient health by providing new access to health care for rural...more
7/11/2019
/ Bribery ,
Corruption ,
Department of Justice (DOJ) ,
Enforcement Actions ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Physicians ,
Telecommunications ,
Telemedicine ,
White Collar Crimes
A recently published proposed rule expands the functions and responsibilities of state Medicaid Fraud Control Units (MFCUs).
The rule was issued by the Centers for Medicare and Medicaid Services (CMS) and the Office of...more
11/7/2016
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Data Mining ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Investigations ,
Medicaid ,
OIG ,
Prosecutorial Discretion
The Supreme Court of the United States in Universal Health Services, Inc. v. Escobar et al., weighed in on and embraced the implied certification theory of liability within the False Claims Act (FCA)....more
6/22/2016
/ False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Contractors ,
Health Care Providers ,
Implied Certification ,
Material Misrepresentation ,
Medicaid ,
Medicare ,
Mental Health ,
SCOTUS ,
Universal Health Services Inc v United States ex rel Escobar ,
Unlicensed Medical Providers
Good news may be in sight for businesses and health care providers.
On April 28, 2016, the House Judiciary Committee's Subcommittee on the Constitution and Civil Justice once again considered potential updates to the...more
In an important recent decision, the Sixth Circuit Court of Appeals confirmed that a qui tam relator's claim that her former husband improperly accessed electronic protected health information (e-PHI) of her and her relatives...more
On July 14, 2015, CMS issued a report regarding its implementation of the Fraud Prevention System, which uses predictive analytics to manage government fraud and False Claims Act investigations. According to this report, CMS...more