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Fraud: Skilled Nursing Facilities And Nursing Homes

by Michael Volkov on

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

Private Health Insurance Efforts To Fight Fraud

by Michael Volkov on

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

by Michael Volkov on

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

Targeting Healthcare Fraud by Data Mining

by Michael Volkov on

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

by Michael Volkov on

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

by Michael Volkov on

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

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

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

Qui Tam Relator Not Original Source; U.S. ex rel. Repko v. Guthrie Clinic

In U.S. ex rel. Repko v. Guthrie Clinic et al., the Third Circuit recently ended an attempt by Rodney Repko, former general counsel and executive vice president for Guthrie Healthcare System and its related entities, to bring...more

Introduction of the Private-Public Partnership and the Future of Fraud Claims

by Foley & Lardner LLP on

On July 26, 2012, the U.S. Department of Health and Human Services (HHS) and the U.S. Attorney General’s Office announced that the federal government is creating a partnership with private payers and other state and private...more

Health Care Fraud Enforcement: Current Trends

by Michael Volkov on

Health care fraud enforcement continues to rack up successes. Prosecutors are employing aggressive investigative techniques and using non-health care fraud related statutes to prosecute individuals. ...more

Health Law Alert: Massive Criminal Takedown Is Latest Salvo in Government's Intensified Campaign Against Health Care Fraud and...

by Baker Donelson on

On May 2, 2012, the Justice Department and the U.S. Department of Health and Human Services (HHS) announced a nationwide takedown of 107 individuals for Medicare fraud schemes involving approximately $452 million in false...more

Medicare Strike Force Team Charges 107 Individuals for Approximately $452 Million in False Billing

by King & Spalding on

On May 2, DOJ and HHS announced charges against 107 individuals, including doctors, nurses and other licensed medical professionals, across the country for allegedly participating in Medicare fraud schemes totaling $452...more

Medicare Fraud Strike Force Bust Involves Highest Amount of False Billings in a Single Takedown

2012 is already a record-breaking year in health care fraud enforcement. This week Attorney General Eric Holder and Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius announced the biggest...more

HHS Plugs Payment Suspensions as Key Tool in Latest Takedown

by Morgan Lewis on

The Medicare Fraud Strike Force's use of a pivotal ACA regulation to suspend payments during criminal investigations signals a turning point in its prosecution strategy. On Wednesday, May 2, U.S. Attorney General Eric...more

Senate Committee Holds Hearing on Health Care Fraud Enforcement

A hearing titled Anatomy of a Fraud Bust: From Investigation to Conviction held by the Senate Committee on Finance (Committee) on April 24th allowed federal health care agencies to both tout their fraud-fighting successes,...more

Industry Trends in Criminal Health Care Fraud Enforcement -- Part III in a Continuing Series on Health Care Enforcement

This third, and final, installment in the “Year in Review” series examines how criminal health care fraud enforcement has changed in the past year, including the use of non-health-care-related statutes, the focus on specific...more

OIG Publishes Solicitation for Comments on New and Modified Safe Harbors Under the Federal Anti-Kickback Statute and New OIG...

by Epstein Becker & Green on

On December 29, 2011, the Office of Inspector General of the Department of Health and Human Services ("OIG") published its annual notice ("Solicitation") soliciting recommendations and proposals for developing new and...more

New Mexico Ignition Interlock - Informational Flyer

by Salim A. Khayoumi on

Arrested for DWI in New Mexico? How to get your Ignition Interlock License....more

DOJ Escalates Its War on Health Care Fraud: GlaxoSmithKline Agrees to Pay Record-setting $3 Billion to Settle U.S. Investigations

by Morrison & Foerster LLP on

British pharmaceutical company GlaxoSmithKline (GSK) announced on November 3, 2011, that it had reached an agreement in principle with the United States government to resolve multiple federal investigations regarding the...more

Insurance & Regulatory Update: Minnesota's Department of Commerce in the News

Although the Minnesota Department of Commerce's windows are shuttered (hopefully not too much longer) while the Governor and the Republican-controlled Legislature continue to butt heads while working to hammer out a budget...more

Conducting Business Abroad: What Are the Risks Under the FCPA?

Your company is entering a new market overseas. You hire a local lawyer to help you navigate the steps necessary to obtain a license to conduct business in that country. Once you get your license, you hire third-party sales...more

A Co-Insured's Arson Will Not Burn Coverage

A fire insurance policy that excludes coverage for intentional acts or criminal conduct of "any" insured does not preclude coverage for innocent insureds who suffer loss because of a co-insured's intentional or criminal acts....more

STATE OF CALIFORNIA V. DOLEZAL & LANGLEY

COMPLAINT

by Bonnie Merrick on

These are administrative code violations. The Department of Insurance promulgated these regulations and also has the authority to enforce them. ROLE OF COURTS In considering administrative law issues, the courts must...more

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