Insurance, Criminal Law, Health Law

Arrests Made and Investigation Underway at a Chicago Hospital

by King & Spalding on 4/23/2013

On April 16, 2013, the United States Department of Justice (DOJ) and U.S. Attorney’s Office in the Northern District of Illinois announced the arrest in Chicago of the owner and senior executive of Sacred Heart Hospital...more

Health Care Enforcement in 2012: A Year in Review

by Hope Foster, Samantha Kingsbury, Tracy Miner, Jessica Sergi, Stephanie Willis | Mintz Levin - Health Law on 2/26/2013

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

Too Big to Exclude; Too Much Wrongdoing to Ignore

by Melissa Brown, Robert Wolin | BakerHostetler on 2/26/2013

A 2007 audit initiated by a Medicare Program Safeguard Contractor (PSC) discovered that a North Carolina provider had a high incidence of inpatient billings for patients who did not stay in the hospital overnight. The PSC's...more

Protecting Your Hospital From Over-Utilization Prosecutions

by Michael Volkov on 2/22/2013

The government has been increasing its focus on healthcare fraud involving “quality” of care. This is an extremely difficult issue, especially for prosecutors. It is very difficult to define “quality” standards and then...more

Expect Increased Medicare Denials for Incarcerated Beneficiaries and Unlawful Aliens

by Leslie Demaree Goldsmith | Ober|Kaler on 2/22/2013

The Department of Health and Human Services’ Office of Inspector General (OIG) recently published two reports finding Medicare improperly paid providers millions of dollars for incarcerated beneficiaries and unlawful aliens...more

Hospitals And Fraud Enforcement

by Michael Volkov on 2/19/2013

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

10 Fraud and Abuse Enforcement Trends You Can't Afford to Ignore in 2013

by Cory Fox, Gregory Saikin | BakerHostetler on 2/15/2013

To paraphrase a famous quote, "Those who do not learn from history are doomed to repeat it," and providers who ignore the significance of the federal government's healthcare fraud enforcements efforts in 2012 do so at their...more

Judge Approves Two-Year Delayed Prosecution of WakeMed

by King & Spalding on 2/14/2013

A Federal district court judge issued a February 8, 2013 order granting a delayed prosecution against Raleigh, NC-based WakeMed Health and Hospitals for allegedly submitting false inpatient bills to Medicare. The...more

False Claims Act - Health System Settles Allegations Related To Payments To Physician Advisors

by BakerHostetler on 2/14/2013

The U.S. Department of Justice (DOJ) recently issued a press release related to a settlement agreement between the U.S. Attorney's Office for the District of New Jersey, the state of New Jersey and the Cooper Health System...more

California Gets Tough on Healthcare Fraud and Abuse: Are You Protected?

by Matthew Chayt | Nossaman LLP on 1/31/2013

The industry should take note of new California anti-fraud laws that have recently gone into effect—and the increasing challenges of compliance in a rapidly transforming industry. Even as lawmakers in Sacramento debate how...more

When Will They Learn? Doctors Continue to Face Antitrust Charges for Jointly Negotiating Contracts without Clinical or Financial...

by Jonathan Lewis | BakerHostetler on 1/29/2013

Legitimate joint marketing and selling arrangements have the potential to produce efficiencies. This is particularly so, for example, where the arrangement enables the participants to make or market products that they could...more

Fraud: Skilled Nursing Facilities And Nursing Homes

by Michael Volkov on 1/7/2013

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 12/13/2012

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 12/11/2012

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 10/17/2012

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 10/15/2012

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

Physicians and Pharmacies Must Be Aware of the Dangers and Potential Penalties Associated with Importing Prescription Drugs

by Fuerst Ittleman David & Joseph, PL on 10/11/2012

Introduction - As the price of healthcare continues to increase, healthcare practitioners have become more innovative and creative in their attempts to keep costs affordable for their patients. One technique which has...more

Healthcare Prosecutions for Failures to Return Overpayments

by Michael Volkov on 10/11/2012

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

Federal Anti-Fraud Efforts Get Added Attention

by John Grady on 10/5/2012

Presidential Campaign draws attention to ongoing Anti-Fraud Efforts. The Medicare Fraud Strike Force, a partnership between HHS and DOJ designed to target emerging and migrating health care fruad schemes and chronic fraud...more

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

by Mintz Levin - Health Law on 9/26/2012

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

by Mintz Levin - Health Law on 8/21/2012

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

by Mintz Levin - Health Law on 8/17/2012

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

D.C. Circuit Affirms HHS Power to Disqualify Corporate Officials Convicted of Misdemeanors Under the "Responsible Corporate...

by Duane Morris LLP on 8/8/2012

On July 27, 2012, the U.S. Court of Appeals for the D.C. Circuit issued the long-anticipated decision in Friedman v. Sebelius. Friedman addressed whether the U.S. Department of Health and Human Services (HHS), through its...more

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

by Foley & Lardner LLP on 7/30/2012

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

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