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The Medicaid Fraud Control Units: Fiscal Year 2014 Report

The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs)...more

Fraud So Complicated It Takes a Neurosurgeon

Generally, when a doctor is convicted for fraud, the misdeeds are limited to a single category of fraud. Maybe the doctor charged for procedures that weren’t performed; maybe there were kickbacks for referrals; or maybe...more

Physicians as whistleblowers: Doctors get rich by exposing fraud

As the federal and state governments have evolved from Uncle Sam to Doctor Sam, the potential for healthcare waste, fraud and abuse has also increased. One way the government has deterred healthcare fraud is by enacting and...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases

Trends & Analysis - ..We have identified 67 health care–related qui tam cases that have been unsealed since the cases covered in our last Qui Tam Update. Of those cases, 29 were filed before January 1, 2014, with seven...more

Reasonable Suspicion of a Crime in a Long-Term Care Facility and OIG Findings

On June 17, 2011, CMS published a memorandum detailing the reporting requirements when there is a reasonable suspicion of a crime in a long-term care facility as required by section 1150B of the Social Security Act....more

Hospital CFO Must Pay $4.4 Million For Falsely Attesting To Meaningful Use

The Health Information Technology for Economic and Clinical Health Act, adopted in 2009, pumped billions of dollars into hospitals and physicians (through the Centers for Medicare and Medicaid) in order to stimulate them to...more

The Medical-School-to-Prison Pipeline Continues to Widen

Physicians now appear to be more than ever at a greater risk of investigation for healthcare crimes, largely due to their “gatekeeping” function concerning a patient’s need for medical services and the government’s increased...more

House Approves "Ensuring Patient Access and Effective Drug Enforcement Act"

On April 21, 2015, the House of Representatives approved H.R. 471, the Ensuring Patient Access and Effective Drug Enforcement Act of 2015. The bipartisan legislation would clarify the Controlled Substances Act to establish...more

Four Takeaways from the ABA Antitrust Section’s 2015 Spring Meeting

This year's 63rd ABA Section of Antitrust Law Spring Meeting featured extensive remarks from antitrust regulators forewarning of more vigorous antitrust enforcement in 2015. The Proskauer antitrust team was on the ground and...more

Blog: Fraud Watch: Laboratory Referrals Under Government Scrutiny

Significant recent regulatory and enforcement activity related to laboratory fees and services continues to demonstrate an increased focus on this industry. Government enforcers are active in cases involving both the...more

DOJ Announces Indictment of U.S. Senator Menendez and Friend Salomon Melgen for Conspiracy, Bribery, and Honest Services Fraud

On April 1, the DOJ indicted Senator Robert Menendez and Florida ophthalmologist Salomon Melgen for an alleged bribery scheme in which Menendez accepted financial gifts from Melgen in exchange for using his position of power...more

DOJ and HHS Annual Report Highlights $3.3 Billion in Settlements and Judgments in FY 2014

On March 19, 2015, the Department of Justice (DOJ) and Department of Health and Human Services (HHS) issued their annual Health Care Fraud and Abuse Control (HCFAC) Program report highlighting that the HCFAC Program obtained...more

Developments in White Collar Criminal Enforcement: The Government Remains Aggressive, and the Courts' Reaction Is Mixed

The first quarter of 2015 witnessed a continuing effort by government lawyers to push the boundaries of criminal statutes in white collar cases—from health care fraud to corporate misconduct and beyond. Two recent cases...more

Health Care Fraud and Abuse Control (HCFAC) Program Reports $3.3 Billion in Recoveries

According to the FY 2014 HCFAC program report, more than $3.3 billion was recovered in FY 2014 as a result of the government’s health care fraud judgments and settlements, including $2.3 billion won or negotiated by the...more

Worthless Services Investigations and Settlements: The Enforcement Trend Continues

In recent years, state and federal governments have shown their willingness to criminally pursue skilled nursing home owners and operators for allegedly administering “worthless” or substandard quality of care to their...more

Should Health Care Providers Pay Attention to the Seventh Circuit’s New Definition of “Referral”? – Part Two

Tuesday’s post discussed the Seventh Circuit’s holding in United States v. Patel, broadly expanding the definition of “referring” under the Anti-Kickback Statute. Today’s post turns to the question of how other circuits have...more

Update on the DOJ's Criminal Investigation into Generic Pharmaceuticals

The Department of Justice Antitrust Division's (DOJ's) investigation into the generic pharmaceutical industry may be expanding. On March 15, 2015, a third generic manufacturer disclosed that it received a subpoena from the...more

Is Health Care Fraud on the Rise? Or Just the Accusations??

Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in...more

Manhattan U.S. Attorney Prevails in Securities Fraud, RICO Case

The SEC has brought a series of investment fund fraud and Ponzi schemes. Indeed, the Commission has brought so many of these cases in recent years they have become a staple....more

Medical Device Companies Face Severe FCA Penalties for TAA Violations

A spate of recent multi-million dollar settlements has shown that medical device manufacturers are subject to substantial liability under the False Claims Act (FCA) if they misstate the country of origin of their products in...more

MA Risk Adjustment in the 2016 Call Letter and … in Health Care Fraud Charges

In past Call Letters, CMS has proposed and finalized significant changes to the Medicare Advantage risk adjustment system including, recalibrations, deletions and additions of diagnoses codes, and questioning of the value of...more

Seventh Circuit Upholds Physician’s Conviction for Violation of the Anti-kickback Law Based on Expansive Definition of “Referral”

On February 10, 2015, the U.S. Court of Appeals for the Seventh Circuit upheld the conviction of Dr. Kamal Patel for violation of the anti-kickback law, reinforcing a broad definition of “referring” under the statute (U.S. v....more

Supreme Court Update: North Carolina Board Of Dental Examiners V. Federal Trade Commission (13-534), Kansas V. Nebraska (126,...

The robed returned to action with this week with decisions in three cases, North Carolina Board of Dental Examiners v. Federal Trade Commission (13-534), on whether state licensing boards enjoy immunity from antitrust laws...more

CMS Delays 60-Day Rule, But Overpayment Case Law Emerging

The Centers for Medicare & Medicaid Services (CMS) recently announced a one-year delay in finalizing the long-awaited and closely watched rule addressing the 60-day deadline to return Medicare and Medicaid overpayments (the...more

Roadmap to Prison: Lessons Learned from the Criminal Prosecution of Alpha Ambulance’s Leaders

No one running an ambulance company ever planned to go to prison for doing his or her job. But that is a real possibility if the government knocks on the door, and the owner or manager is dishonest in his or her response to...more

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