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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

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

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