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Recent Cases of Interest to Regulators

Off Duty Conduct - Fountain v. British Columbia College of Teachers, 2013 BCSC 773 (British Columbia Supreme Court) - Fountain, a teacher, fired a shot from a rifle over the heads of his sons in the aftermath of...more

HHS Issues Privacy Rule Guidance for Law Enforcement Agencies

The Office for Civil Rights (OCR) of the Department of Health and Human Services recently announced the release of its guidance, “Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: A Guide for Law...more

"Ranbaxy Resolves Criminal and Civil Charges Through Record Settlement"

Executive Summary - On May 13, 2013, generic drug manufacturer Ranbaxy USA Inc. (Ranbaxy), a subsidiary of Indian generic drug manufacturer Ranbaxy Laboratories Limited, pled guilty to seven felony charges as part of a...more

Massachusetts 2013 – 2014 Legislative Session Preview

The 188th Massachusetts Legislature began the 2013 – 2014 legislative session on January 2. This alert identifies the key public policy issues that will likely emerge in the current session and offers insight into their...more

U.S. Government’s Use of the "Park Doctrine" to Police Pharmacies

The U.S. government may be resurrecting the "Park Doctrine" as a tool to prosecute the owners of pharmacies for federal Food, Drug, and Cosmetic Act (FDCA) violations. In United States v. Park, 421 U.S. 658 (1975), the U.S....more

Fraud: Skilled Nursing Facilities And Nursing Homes

When it comes to healthcare fraud enforcement, the government knows how to target its resources. It is estimated that at least 25 percent of all claims paid by Medicare are improper. The government understands the...more

2013 Brings Significant Criminal Background Check Changes for Ohio HHAs

The Ohio Department of Health has proposed new administrative rules scheduled to take effect January 1, 2013 that will significantly impact the obligations of a home health agency (“HHA”) regarding background checks of its...more

Private Health Insurance Efforts To Fight Fraud

Healthcare fraudsters do not discriminate between private and public health insurance. Fraudsters use similar schemes to defraud Medicare and Medicaid and private insurance companies. ...more

Plugging The Leak: Tackling The Problem Of Healthcare Fraud

The Justice Department and the Department of Health and Human Services have made healthcare fraud a number one priority – it is another example of the synergy of politics and enforcement. Congress spends more money on...more

DOJ Touts Active Enforcement of the False Claims Act in FY 2012

In a briefing earlier this week, Acting Associate Attorney General Tony West proudly reported that in FY 2012 the Department of Justice (DOJ) set a new single year record of nearly $5 billion in settlements and judgments...more

An Ounce of Prevention Is Worth a Pound of Cure Why You Need an Effective Compliance Program

For centuries, health care providers have enlightened patients with the well-known adage: “an ounce of prevention is worth a pound of cure.” A recent set of cases involving a durable medical equipment company and its...more

Massachusetts: Medical Marijuana Industry’s Steep Hill to Climb

In November 2012, Massachusetts voters passed a ballot initiative authorizing medical marijuana. This article examines some of the obstacles faced by the industry, legislators, regulators and law enforcement officials prior...more

EMRs: The New Health Care Fraud Frontier?

Whether referred to as electronic medical records, electronic health records, or electronic patient records, there is no doubting the tremendous potential benefits that the digitization of medical data holds for the health...more

DOJ and SEC Issue Highly Anticipated FCPA Guidance

On November 14th, the U.S. Department of Justice (“DOJ”) and the U.S. Securities and Exchange Commission (“SEC”) published A Resource Guide to the U.S. Foreign Corrupt Practices Act, their long-awaited, highly anticipated...more

Medical Marijuana: Weeding Through the New Massachusetts Law

Massachusetts voters passed a referendum question eliminating state criminal and civil penalties for the medical use of marijuana by patients with certain “debilitating medical conditions,” including cancer, glaucoma, HIV,...more

Who is Committing Healthcare Fraud?

The financial recoveries for healthcare fraud are staggering. The Justice Department and Health and Human Services (Office of Inspector General (“OIG”) and Centers for Medicare and Medicaid Services (“CMS”)) regularly...more

Targeting Healthcare Fraud by Data Mining

The Department of Justice continues to trumpet its healthcare fraud program. Just last week, the Justice Department and HHS announced another nationwide sweep resulting in the arrest of 91 individuals....more

Targeting Hospitals for Civil and Criminal Prosecutions

Hospital administrators should be nervous. The Justice Department and HHS are out to pressure service providers, including hospitals and doctors, to reduce costs. In Washington, hospitals and doctors are perceived to be a...more

Healthcare Prosecutions for Failures to Return Overpayments

Sometimes the deck is stacked against you. No matter what you do and how hard you try, you will lose. In the healthcare area, hospitals, doctors and other service providers have to feel the frustration when it comes...more

Corporate Integrity Agreements and Anti-Corruption Compliance Schedules

It is interesting to compare how the Justice Department handles compliance issues in different contexts. The Justice Department, with the Office of Inspector General/Health and Human Services, enters into Corporate...more

State and Federal Pharmaceutical Enforcement Litigation: What’s Next?

I recently co-chaired an American Conference Institute (ACI) forum on Pharmaceutical Pricing Litigation, which featured a number of key players who provided their unique perspectives on state and federal litigation involving...more

In ‘Bitter Pill,’ FDA Seizes Domain Names of Firms Selling Illegal Pharmaceuticals

In an aggressive step against businesses selling drugs online, the U.S. Food and Drug Administration, in conjunction with the U.S. Department of Homeland Security, took legal action earlier this month against more than 4,100...more

Joint CMS, DOJ Letter on EHR’s Potential for Billing Fraud; AHA, AAHC Respond

Secretary Sebelius and Attorney General Holder issued a joint letter to the American Hospital Association and four other associations representing hospitals and medical centers, warning of indications that some providers are...more

The Top 5 Corruption Risks for Pharmaceutical and Medical Device Companies

Pharmaceutical and medical device companies are fast becoming the enforcement punching bag, eclipsing the long-suffering status of the oil and gas energy. If you ignore the political and public relations challenges facing...more

Multi-Million Medicare Fraud and HIPAA Conviction: A Cautionary Tale

The owner of a Long Island medical supply company was convicted last week on charges of a $10.7 million Medicare fraud and wrongful disclosure of private medical information under the Health Insurance Portability and...more

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