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Centers for Medicare & Medicaid Services (CMS) Fraud Healthcare Fraud

Benesch

Dental/DSO Intelligence Monthly Report: July/August 2024

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Background on Indiana’s “Baby HSR” Law - Indiana passed Senate Bill 9 in March 2024, which requires an Indiana healthcare entity involved in a merger or acquisition with another healthcare entity with a value of at least...more

Sheppard Mullin Richter & Hampton LLP

Should my Company Self-Disclose Major Fraud? The Answer is Now Clear

After conducting a thorough and privileged internal investigation, it becomes evident that your Company has overcharged the government over $50 million, and that the fraud was directed by a high-level manager. What do you do...more

BCLP

U.S. Health Care Industry Takes Note: U.S. Supreme Court 2023 Attention on False Claims Act

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This Tuesday, April 18, 2023, the U.S. Supreme Court heard argument in U.S. v. SuperValu. SuperValu is the second – and more consequential – False Claims Act (FCA) case of the term....more

Bass, Berry & Sims PLC

False Claims Act Fundamentals: Self-Disclosures

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When healthcare providers and other government contractors are subject to scrutiny for bills submitted to the government, it is often the result of a whistleblower complaint filed under the qui tam provisions of the False...more

Benesch

Dialysis & Nephrology Digest - August 2022

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DOJ files civil complaint alleging Fresenius performed unnecessary procedures on dialysis patients - In June, it was revealed that DOJ would partially join a whistleblower lawsuit against the dialysis provider. In a civil...more

Goodwin

OIG Alert and DOJ Enforcement Action Summary: Telemedicine Arrangements

Goodwin on

The July 20, 2022 Special Fraud Alert describes findings from what OIG describes as “dozens of investigations of fraud schemes involving companies that purported to provide telehealth, telemedicine, or telemarketing services”...more

Venable LLP

HHS 2021 Semiannual Report to Congress Draws Attention to Genetic Testing, Durable Medical Equipment, and Opioid Disorder...

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On June 6, 2022, the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), released its spring 2022 semiannual report to Congress. The semiannual report covers the period of October 1, 2021 to...more

Mintz - Health Care Viewpoints

DOJ Announces Another Wide-Ranging COVID-19 Fraud Enforcement Action

For the last few years, we have been closely monitoring and reporting on COVID-19 related fraud enforcement efforts by federal agencies. We detailed those findings in our Health Care Enforcement 2020 Year in Review & 2021...more

King & Spalding

COVID-19 Health Care Fraud Enforcement on the Rise: What’s Ahead for the Life Sciences & Healthcare Industries

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On April 20, 2022, the Department of Justice (“DOJ”) announced twenty-one (21) defendants were charged in nine (9) different districts related to $149 million in COVID-19-related false billing issues. $8 million in cash and...more

Mintz - Health Care Viewpoints

Five Takeaways from DOJ’s Latest National Enforcement Action, Including Continued Focus on Opioids and Telemedicine

The U.S. Department of Justice (DOJ) recently announced its latest national enforcement action related to health care fraud (National Enforcement Action) in which DOJ filed criminal charges against 142 defendants. The...more

King & Spalding

OIG Releases Semiannual Report to Congress

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On May 28, 2021, OIG released its Semiannual Report to Congress (the Report). The Report describes OIG’s work during the 6-month semiannual reporting period of October 1, 2020, through March 31, 2021 (the Semiannual Reporting...more

ArentFox Schiff

Investigations Newsletter: Individual Prosecutions Down But Corporate Resolutions Steady for DOJ’s Fraud Section in 2020, with...

ArentFox Schiff on

Individual Prosecutions Down But Corporate Resolutions Steady for DOJ’s Fraud Section in 2020, with More in the Pipeline - The Department of Justice’s (“DOJ”) Fraud Section recently released a year-in-review report that...more

Snell & Wilmer

Telehealth Fraud Triggered by COVID-19 Pandemic

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On January 14, 2021, the Department of Justice announced that it had obtained over $2.2 billion in settlements and judgments from fraud and False Claims Act cases over the previous fiscal year. More than 80 percent of False...more

ArentFox Schiff

Investigations Newsletter: HHS Announces Formation of FCA Working Group

ArentFox Schiff on

HHS Announces Formation of FCA Working Group - On December 4, 2020, the US Department of Health and Human Services (HHS) announced that it is creating a False Claims Act Working Group to enhance the partnership between...more

Lathrop GPM

Just What the DOJ Ordered: Telehealth Enforcement Actions Are Here to Stay

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Since the worldwide spread of COVID-19, the demand for telehealth services has surged. The Centers for Medicare and Medicaid Services (CMS) reported over an 11,000% increase in virtual visits (i.e., video- or phone-based...more

ArentFox Schiff

Investigations Newsletter: Russian National Sentenced to Prison for $100 Million Cyber Fraud Conspiracy

ArentFox Schiff on

Russian National Sentenced to Prison for $100 Million Cyber Fraud Conspiracy - On October 30, 2020, a Russian national was sentenced to eight years in prison for his role in a scheme to illicitly obtain and use sensitive...more

Seyfarth Shaw LLP

Insurers, ERISA Plans and Other Payors:  Beware of COVID-19 Fraud Schemes!

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On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) issued an alert to the public about fraud schemes related to the novel coronavirus (COVID-19)....more

Foley & Lardner LLP

Telemedicine and Digital Health Companies Will Benefit from Newly-Proposed Fraud and Abuse Waivers

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The OIG recently released proposed revisions to the Anti-Kickback Statute (AKS) and Civil Monetary Penalties (CMP) Law. Several of these changes, if finalized, will directly benefit companies offering telemedicine and digital...more

Epstein Becker & Green

Healthcare Fraud Prevention Partnership Issues a Review of Clinical Laboratory Services

The Healthcare Fraud Prevention Partnership (“HFPP”) recently published its second white paper, entitled “Examining Clinical Laboratory Services,” which provides a comprehensive overview of practices that raise fraud and...more

Manatt, Phelps & Phillips, LLP

Healthcare Fraud Enforcement Trends

Editor’s Note: In just the first year of the Trump administration, healthcare faced an avalanche of change. The disputes arising from the flood of new developments encompass both legal and regulatory challenges—and are being...more

Manatt, Phelps & Phillips, LLP

Health Update - November 2017

Fraud and Abuse 2017: Understanding Trends and Avoiding Actions - Editor’s Note: In a recent webinar for Bloomberg BNA, Manatt examined game-changing fraud and abuse trends and cases—and revealed strategies for avoiding...more

Cooley LLP

Blog: CMS Announces that Data Analytics has Prevented $820M in Improper Medicare Payments

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The Office of Inspector General (OIG) recently certified the “positive return on investment” from the FPS and recommended its continued operation, although the OIG determined that it was not feasible at this time to expand...more

McGuireWoods LLP

Washington Healthcare Update

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This Week: Leading Up to the SCOTUS King v. Burwell Decision... House Votes to Repeal the Medical Device Tax... CMS Announces It Will Bolster Transitional Reinsurance Payments... MedPAC Releases June Report to Congress....more

Akerman LLP - Health Law Rx

What Is Your Fraud Rank?

On June 2, 2015, Center for Medicare & Medicaid Services (CMS), provided direction to state Medicaid Directors on the implementation of Section 6401 of the Affordable Care Act, Provider Screening and Other Enrollment...more

Foley & Lardner LLP

Roadmap to Prison: Lessons Learned from the Criminal Prosecution of Alpha Ambulance’s Leaders

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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

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