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Health Criminal Law

Read need-to-know updates, commentary, and analysis on Health issues written by leading professionals.

Medicaid Fraud Control Units Report Focus on Personal Care Services

by Ruder Ware on

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released a report summarizing activities of State Medicaid Fraud Control Units (MFCUs or Units) for fiscal year 2016. The OIG is the...more

Reimbursement Manager Pleads Guilty for Prior Authorization Process Issues

by Bass, Berry & Sims PLC on

On Monday, June 19, 2017, Elizabeth Gurrieri became the second former employee of Insys Therapeutics (Insys) to plead guilty to federal anti-kickback charges related to the drug Subsys, an expensive fentanyl-based painkiller....more

The Past, Present, and Future of Government Regulation of Off-Label Communications – Part 3

This is Part 3 in my series exploring the history of FDA’s regulation of off-label communications, which has become newly relevant in light of the recent events highlighted in Part 1. In this installment, I continue...more

Update on Regulatory Compliance in the Global Health Care Industry

by Baker Ober Health Law on

A comprehensive understanding of the constantly evolving layers that make up federal anti-corruption statutes, sanctions regulations and export control restrictions is imperative for both the pharmaceutical and health care...more

Twelve-Year Sentence for Medicaid Diaper Scam

by Faegre Baker Daniels on

Maria Paz Garza was the King Midas of incontinence supplies: she turned diapers into dollars—over two and a half million of them, according to the government’s indictment. She did it through a scheme that charged Texas...more

SEC and U.S. Attorney’s Office Continue Their Pursuit of Criminal Actions Against Purveyors of “Political Intelligence”

by Foley & Lardner LLP on

On May 24, 2017, the United States Attorney’s Office for the Southern District of New York and the Securities and Exchange Commission (SEC) launched their latest criminal and civil salvos against prohibited insider trading by...more

Interpreting the renewed Rohrabacher-Farr Amendment: A loophole for enforcement?

by Thompson Coburn LLP on

In 2013, the U.S. federal government shut down while federal legislators debated about various political issues of the year. However, during that debate, an amendment was added to the final spending bill that stated as...more

New York Man Sentenced To 10 Years In Prison For Involvement In $26 Million “Billing Mill”

by Fox Rothschild LLP on

Last month, a New York man was sentenced to 10 years in prison for allegedly operating a $26 million scheme to defraud Medicare and Medicaid. The defendant allegedly established 6 medical clinics in Brooklyn that paid elderly...more

Government Leaks Lead to Landmark Insider Trading Case

On May 24, 2017, the SEC for the first time brought charges based on allegations of insider trading on confidential government information. The alleged insider trading scheme involved tips related to three announcements by...more

Seven Takeaways from the ABA National Institute On Health Care Fraud

On May 17, 2017 the American Bar Association convened its 27th National Institute on Health Care Fraud. I have attended many of the past annual meetings, and always enjoy the presentations and the opportunity to network with...more

Former Lutonix VP Pleads Guilty to Trade Secret Theft

by Knobbe Martens on

On May 9, 2017, according to court records, Christopher Barry, former Vice President of R&D at Lutonix Inc., pled guilty to stealing Lutonix’s trade secrets in the form of several confidential electronic files....more

WannaCry Malware and Medical Device Security

by Knobbe Martens on

The WannaCry virus has infected and frozen computers in many industries around the world. According to a news source report, the virus has extorted doctors and hospital administrators for the keys to unlock and regain access...more

Ransomware Attack – Quick Facts

By now, you may have heard about the global ransomware attacks affecting health care and other organizations throughout the world, in particular the United Kingdom, but also in the United States. The ransomware variant,...more

Can Overpayments Create Criminal Liability?

by Ruder Ware on

We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges...more

Sally Yates’ was Already Famous for Changing the Focus of Compliance Investigations - The Yates Memorandum

by Ruder Ware on

By now the whole world knows about Sally Yates. We are likely to see a lot more of her as a central figure in Congressional investigations. For some of us who deal with compliance investigations, Sally Yates was famous long...more

A “Change of Heart” in a Health Care Fraud Prosecution - Inconsistent angiogram interpretations establish reasonable doubt in...

On March 7, 2017, the U.S. District Court for the Eastern District of Kentucky reversed the October 27, 2016 criminal jury verdict against Kentucky cardiologist Dr. Richard E. Paulus, and acquitted him on all counts of health...more

Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

by Ruder Ware on

Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more

This Month in Corruption: Smuggled Drugs, Bogus Billing, Tampered Equipment

by PretiFlaherty on

Wrong Way to Keep Prisoners in Line. The office of William D. Weinreb, acting U.S. Attorney for the District of Massachusetts, announced March 3 that two former corrections officers at the Essex County Correctional facility...more

AG's latest remarks signal no outright campaign against cannabis yet

by Thompson Coburn LLP on

On March 2, 2017, it seemed as if the U.S. Department of Justice was aiming to crack down on the U.S. cannabis industry in a way not seen since before the previous administration. U.S. Attorney General Jeff Sessions and White...more

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

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

President’s Budget Blueprint Increases Funds For Health Care Fraud Enforcement

The President has released a “budget blueprint” for fiscal year 2018. Although there are many aspects of the budget blueprint to digest, several budget items signal that government health care fraud enforcement remains a...more

Pharmaceutical Manufacturers and Healthcare Leaders cite Fraud and Abuse Laws as Obstacle to Value-Based Arrangements

As the healthcare industry moves towards value-based purchasing, pay-for-performance, and other payment reform models, industry leaders have identified federal fraud and abuse laws as a barrier to full implementation of such...more

Health Care FCA Decisions Applied to Criminal Case

by Bryan Cave on

False Claims Act (“FCA”) cases involving medical necessity continue to receive great attention. A March 7, 2017 opinion that overruled a jury’s criminal fraud conviction of a cardiologist demonstrates the broader implications...more

"Trends in Corporate Integrity Agreements Reflect New HHS OIG Guidance on Use of Exclusion Authority"

2016 was a year of change for the Department of Health and Human Service's Office of Inspector General's (OIG) approach to corporate integrity agreements (CIA). The OIG began to use its new model CIA format and applied its...more

DOJ Issues New Guidance on the Evaluation of Corporate Compliance Programs in Federal Fraud Investigations

On February 8th, the U.S. Department of Justice (DOJ) quietly issued new guidance on how the agency evaluates corporate compliance programs during fraud investigations. The guidance, published on the agency’s website as the...more

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