Health Criminal Law

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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

2014—A Record-Setting Year for Whistleblowers

2014 was a record-breaking year for whistleblowers, including both the U.S. Department of Justice’s prosecution of cases under the False Claims Act (FCA) and the U.S. Securities and Exchange Commission’s prosecution of cases...more

California Lawyer 2015 Roundtable Series: White-Collar Defense

The latest developments in white-collar criminal law include a gamechanging decision on insider trading, new sentencing guidelines for fraud convictions, more options for filing charges under the bank fraud statutes, and a...more

7th Circuit Court of Appeals Creates Expansive Definition of “Referral” Under the Anti-Kickback Statute

On February 10, 2015, in United States v. Patel (Case No. 14-2607), the Seventh Circuit Court of Appeals ruled that a physician makes a “referral” within the meaning of the federal health care programs Anti-Kickback Statute...more

New Russia Law Sets Tougher Penalties on Medicines and Medical Devices

On December 31, 2014 Federal Law No. 532-FZ was enactedOn Amending certain Legislative Acts of the Russian Federation in Connection with Interdiction of Falsified, Counterfeit, Poor-Quality and Unregistered Medicines, Medical...more

HIPAA' s Criminal Charges Pack a Heavy Punch

Almost all healthcare providers and health plan administrators are familiar with the detailed requirements of the privacy and security rules under the Health Insurance Portability and Accountability Act (HIPAA). Violations...more

Supreme Court of Canada Releases Landmark Decision on Assisted Suicide

On Friday, the Supreme Court of Canada released its landmark end-of-life decision in Carter v Canada (Attorney General). The Court unanimously held that the prohibition on aiding or abetting a person to commit suicide in the...more

Government's Health Care Fraud "Cash Cow" Keeps Mooing [Video]

The U.S. government has changed up its approach to criminal health care fraud prosecutions, joining forces with fiscal intermediaries on the civil side to ramp up investigations, and this new tactic has proven to be a cash...more

2014 Year in Review: OPDP Warning and Untitled Letters

In 2014, the Center for Drug Evaluation and Research’s (CDER) Office of Prescription Drug Promotion (OPDP) issued a total of 10 enforcement letters to pharmaceutical manufacturers. Of the 10 letters, nine were Untitled...more

Supreme Court Hears Argument On Two Procedural Issues In False Claims Act Litigation

On January 13, 2015, the United States Supreme Court heard oral argument in Kellogg Brown & Root v. United States ex rel. Carter, No. 12-1497, a False Claims Act (FCA) qui tam case involving allegations of fraudulent billing...more

Ethics in Pharmaceutical Sales: Strengthening Corporate Culture and Preventing False Claims Act Violations

“I didn’t set out to commit a crime. I certainly didn’t set out to hurt anyone… I was kind of a hero, because I helped the company make its numbers every quarter. And I thought I was doing a good thing. I thought I was...more

Health Care Enforcement in 2015: A Look Back on 2014 and Forecasting the Year Ahead

In testimony before the House Oversight and Government Reform Subcommittee on Health Care in April 2011, the now-pending nominee for U.S. Attorney General, Loretta E. Lynch, stated in no uncertain terms that “fighting health...more

Government’s Health Care Fraud “Cash Cow” Keeps Mooing  [Video]

Jan. 9, 2015 (Mimesis Law) -- The U.S. government has changed up its approach to criminal health care fraud prosecutions, joining forces with fiscal intermediaries on the civil side to ramp up investigations, and this new...more

Uncovering Factory Farming - The Effects of Ag Gag Laws [Video]

Ag-Gag laws, or whistleblower laws specific to the factory farming industry, have been prevalent in recent news as new laws are both enacted and struck down in states across the nation. These laws illuminate the...more

Skilled Nursing Facilities: Steps for Reducing FCA Liability

Several government agencies have voiced concerns related to the level of therapy services necessary to care for residents of Skilled Nursing Facilities (SNFs). The level of therapy services indicated for SNF residents...more

OIG Releases Fiscal 2014 Report to Congress

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) released its Semiannual Report to Congress (Report) last week summarizing health care fraud investigation activities for the...more

Federal Prosecutors Charge NECC Employees with Second Degree Murder: A Shot Across the Bow to Healthcare Companies Navigating...

Federal prosecutors charged the head pharmacist and the president of New England Compounding Center (NECC), a now-bankrupt Massachusetts compounding pharmacy, with second-degree murder and racketeering in the U.S. District...more

Supreme Court Update: Dart Cherokee Basin Operating Co. V. Owens (13-719) And Heien V. North Carolina (13-604)

Greetings, Court fans Long before he became Chief, John Roberts quipped that "[o]nly Supreme Court justices and schoolchildren are expected to and do take the entire summer off." Right now, the Justices are in the midst...more

Buy High, Sell Low, and Restrict Competition: The Allegations Underlying the Government’s Case Against DaVita and the Implications...

On October 22, DaVita HealthCare Partners Inc., one of the nation’s largest dialysis companies, and its wholly owned subsidiary, Total Renal Care, Inc. (collectively, “DaVita”), agreed to pay $389 Million to settle...more

Africa Update - December 2014 #2

In This Issue: - Leading the News - United States – Africa Relations - North Africa - East Africa - West Africa - Sub-Saharan Africa - General Africa News - Excerpt from...more

Government Applauds Gainsharing, But It's Still Illegal

It's frustrating enough when the government opposes a good idea and makes it illegal. But "gainsharing" presents an even more frustrating situation for hospitals. Why? Because the government continually signals its agreement...more

It’s Risky to Bill Over 24 Hours in a Day

Remember the old joke about the lawyer standing at the pearly gates? He says he’s 52. St. Peter answers, “That’s strange. According to your time records, you’re 89.”...more

Hospital Executive Pleads Guilty to False Meaningful Use Attestation for EHR Incentive Payments

The former CFO of Shelby Regional Medical Center, Joe White, pleaded guilty to knowingly making a false statement related to the hospital’s meaningful use of electronic health records (“EHR”). Shelby Regional had received...more

Vascular Solutions Inc. and its CEO Face Criminal Charges for Selling Unapproved Medical Devices

Last week, the Civil Division of the U.S. Department of Justice (DOJ) filed an indictment charging Vascular Solutions Inc. (VSI) and its CEO Howard Root with (1) selling medical devices without the approval of the U.S. Food...more

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