News & Analysis as of

Department of Justice (DOJ) False Claims Act (FCA) Centers for Medicare & Medicaid Services (CMS)

Hendershot Cowart P.C.

Whistleblower Lawsuit Results In $15 Million Settlement Over Medicare, False Claims Act Violations

Hendershot Cowart P.C. on

On Monday, the Department of Justice (DOJ) announced a record $15 million settlement to resolve claims that Baylor St. Lukes Medical Center, Baylor College of Medicine, and Surgical Associates of Texas were billing Medicare...more

Lathrop GPM

Now is Not the Time to Relax: Record Settlements in Stark Law and False Claims Cases

Lathrop GPM on

In early May 2024, the University of Pittsburgh Medical Center (UPMC) agreed to pay $38 million to resolve a False Claims Act case based on alleged Stark Law violations. The size of the settlement in United States ex rel. J....more

Goodwin

DOJ Files False Claims Act Complaint Against Regeneron, Alleging Fraudulent Eylea Drug Pricing

Goodwin on

​​​​​​​As we previously reported, the U.S. Department of Justice (“DOJ”) filed a lawsuit under the Anti-Kickback Statute against Regeneron Pharmaceuticals in the District of Massachusetts regarding Regeneron’s sales of Eylea...more

Health Care Compliance Association (HCCA)

[Event] Regional Healthcare Compliance Conference - May 9th - 10th, San Juan, Puerto Rico

Looking for compliance education and networking in your area? HCCA’s Regional Healthcare Compliance Conferences offer practitioners convenient, local compliance education on a wide variety of current and emerging topics...more

Gardner Law

[Hybrid Event] “Steer” Clear of Legal Lassos: Readiness Strategies for FDA-Regulated Companies - May 1st, Austin, TX

Gardner Law on

Join Gardner Law for a half-day CLE event in person at the Capital Factory in Austin, TX or attend virtually. Prepare for the regulatory rodeo with confidence by learning how to navigate regulatory, compliance, and privacy...more

Hendershot Cowart P.C.

Doctors: Don’t Fall Victim To Telemedicine Fraud Schemes

Hendershot Cowart P.C. on

Telemedicine companies are supposed to facilitate medically necessary services to beneficiaries over the telephone via licensed medical professionals. In reality, however, many of these “telemedicine companies” are...more

Mintz

EnforceMintz — DOJ’s Continued Focus on Individual Accountability

Mintz on

As discussed in EnforceMintz – Significant 2022 Regulatory and Policy Developments, the Department of Justice (DOJ) issued several memoranda in late 2022 and early 2023, reinforcing DOJ’s approach to individual accountability...more

Mintz

EnforceMintz — Artificial Intelligence and False Claims Act Enforcement

Mintz on

Like most industries, the health care sector is grappling with the uses of artificial intelligence (AI) and what AI means for the future. At the same time, many health care companies already have integrated algorithms and AI...more

Mintz

EnforceMintz — Government Scrutiny of Medicare Advantage Organizations Expected to Continue in 2024

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Medicare Advantage (also known as Medicare Part C) remains a top enforcement priority as evidenced by False Claims Act (FCA) investigations and litigation involving nearly all large Medicare Advantage Organizations (MAOs). As...more

Mintz

EnforceMintz — 2023 Brings Uptick in Cybersecurity Enforcement, Insight Into Potential Risks

Mintz on

After the Department of Justice (“DOJ”) announced its Civil Cyber-Fraud Initiative in October 2021, many in the False Claims Act (“FCA”) bar expected an onslaught of enforcement actions and qui tam cases. The initiative...more

Bass, Berry & Sims PLC

OIG Approves the Use of Gift Cards to Reward Customers' Marketing Efforts

Bass, Berry & Sims PLC on

On January 3, the U.S. Department of Health and Human Services Office of Inspector General (OIG) posted Advisory Opinion 23-15, approving a physician practice consultant’s proposal to offer gift cards to its customers when...more

McDermott Will & Emery

Healthcare Regulatory Check-Up Newsletter | November 2023 Recap

McDermott Will & Emery on

This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for November 2023. We discuss several US Department of Health and Human Services (HHS) agency actions, including the new General...more

Bass, Berry & Sims PLC

HHS Releases Groundbreaking General Compliance Program Guidance, Setting New Standards for Healthcare Entities

Bass, Berry & Sims PLC on

On November 6, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released the most up-to-date, comprehensive, and practical general compliance guidance in decades. The new...more

WilmerHale

Criminal Indictment for Medicare Advantage Fraud

WilmerHale on

The U.S. Department of Justice (DOJ) recently announced a rare criminal indictment involving the Medicare Advantage program—a contrast from DOJ’s more typical use of its civil enforcement authority to pursue similar issues...more

ArentFox Schiff

Investigations Newsletter: Medical Marketer Convicted of $55 Million Fraud Scheme

ArentFox Schiff on

Medical Marketer Convicted of $55 Million Fraud Scheme - Late last week, a federal jury in the Northern District of Texas convicted Quintan Cockerell for his role in a $55 million fraud conspiracy involving TRICARE, a...more

The Volkov Law Group

Cigna Group Falls Under the False Claims Axe and Pays Over $172 Million for Abuse of Medicare Advantage Program

The Volkov Law Group on

As if corporate healthcare businesses needed an enforcement reminder, DOJ recently announced a settlement with Cigna Group for $172 million to resolve claims that Cigna exaggerated patient illnesses to extract more money from...more

ArentFox Schiff

Investigations Newsletter: Engineering Company Agrees to Pay $4.4 Million to Settle FCA

ArentFox Schiff on

Engineering Company Agrees to Pay $4.4 Million to Settle FCA - On Friday, September 15, 2023, the US Department of Justice (DOJ) announced a settlement agreement with Navmar Applied Sciences Corporation, a...more

Health Care Compliance Association (HCCA)

News Briefs: August 14, 2023

Report on Medicare Compliance Volume 32, no 29 (August 2023) In a new Medicare transmittal (12,202), CMS introduced a new place of service (POS) code (27) for “Outreach Site/Street.” POS 27 is defined as “a non-permanent...more

Health Care Compliance Association (HCCA)

[Event] 2023 Healthcare Enforcement Compliance Conference - November 5th - 7th, Washington, DC

Hear directly from the enforcement community - Want to gain insight into properly monitoring, detecting, investigating, and managing violations? Join us at HCCA’s Annual Healthcare Enforcement Compliance Conference to...more

Kramer Levin Naftalis & Frankel LLP

Recent DOJ Settlement With NextGen Highlights Continued Enforcement Focus on Electronic Health Records Technology Vendors

On July 13, NextGen Healthcare Inc. (NextGen), an electronic health record (EHR) software vendor, reached an agreement with the Department of Justice (DOJ) and the Office of Inspector General of the Department of Health and...more

Morrison & Foerster LLP

True Facts About False Claims: MoFo's FCA Newsletter - July 2023

Designed for busy in-house counsel and compliance professionals, this newsletter seeks to bring you up to speed on key federal and state False Claims Act (FCA) developments, with links to primary resources. Each quarter, we...more

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | June 2023 Recap

McDermott Will & Emery on

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for June 2023. We discuss several civil enforcement actions involving false claims, the Anti-Kickback Statute (AKS) and...more

Health Care Compliance Association (HCCA)

FCA Lawsuit Alleges Three Hospitals Were Overpaid PRF ‘High-Impact’ Money and Kept It

Report on Medicare Compliance Volume 32, no 25 (July 2023) The former chief hospital executive of Bayonne Medical Center (BMC) in New Jersey has filed a False Claims Act (FCA) lawsuit alleging the hospital and two others...more

BakerHostetler

Government Scrutiny Expected of Providers That Furnished OTC COVID-19 Tests to Medicare Patients

BakerHostetler on

In April 2022, CMS announced an initiative to pay for Medicare beneficiaries to receive free OTC COVID-19 test kits. Specifically, Medicare established a demonstration project to pay various eligible healthcare providers to...more

McDermott Will & Emery

Healthcare Regulatory Check-Up Newsletter | April 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for April 2023. We discuss several criminal and civil enforcement actions related to the Anti-Kickback Statute (AKS) and the...more

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