Dept. of Justice Medicaid

The United States Department of Justice is a federal executive department established in 1870 by federal statute. The Department is headed by the Attorney General and is responsible for administering and... more +
The United States Department of Justice is a federal executive department established in 1870 by federal statute. The Department is headed by the Attorney General and is responsible for administering and enforcing federal law. The Department is compromised of many different divisions which handle a wide variety of civil and criminal issues.    less -
News & Analysis as of

Whistleblower Receives More Than $17 Million in Omnicare Case

A decision has been made in the case against Omnicare, Inc. that will net a former Omnicare pharmacist more than $17.2 million in the ensuing settlement. The settlement with the Department of Justice orders Omnicare,...more

False claims by any other name: Medtronic and Omnicare cases illustrate the interplay between the False Claims Act and other...

- Government allegations of Medtronic’s alleged incentives to physicians for prescribing its medical devices lead company, while denying wrongdoing, to settle False Claims Act suit predicated on Anti-Kickback...more

The Government Intervenes In False Claims Act Case Alleging Failure To Return Overpayments Within 60 Days

On June 27, 2014, the United States intervened in a qui tam action under the False Claims Act alleging that certain New York hospitals failed to refund Medicaid overpayments within 60 days of identifying them, as required by...more

SDNY Dismisses False Claims Act Complaint, Finding Relators Misconstrued Medicaid Program Legal Framework

A False Claims Act case against the New York City Department of Education (NYCDOE) was dismissed on March 25, the district court holding that Medicaid providers (such as school districts that provide health services) cannot...more

False Claims Act Whistleblower Bounties Exceed $345 Million in Fiscal Year 2013

The DOJ has released its Fiscal Year (“FY”) 2013 totals for civil settlements and judgments recovered under the federal False Claims Act (“FCA”). To say that the Department had a successful year in prosecuting fraud against...more

Does District Court Dismissal of Declined Qui Tam Threaten Future DOJ False Claims Enforcement?

The U. S. Department of Justice (DOJ) has taken the unusual step of appealing a federal district court’s dismissal of a declined qui tam brought under the federal and multiple state false claims acts (FCA). Could the...more

Federal Government Aggressively Pursuing Health Care Fraud

Proactive self-audits help providers identify potential problems - The Federal Government is using every tool available to fight health care fraud and recover overpayments from health care providers. According to the...more

Health Care Reform Update -- May 6, 2013

In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups Scheduled....more

Arrests Made and Investigation Underway at a Chicago Hospital

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 Reform Update -- March 25, 2013

In This Issue: Leading the News; Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more

State Medicaid Enforcement Efforts Net $2.9 Billion in Recoveries for FY 2012

New state health care fraud recovery statistics reinforce that both the federal and state governments remain committed to health care fraud enforcement and demonstrate that their efforts are paying dividends. Earlier this...more

Report Highlights Record-Breaking Year of Enforcement for HHS and DOJ

Yesterday, the Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) released their Annual Report for the Health Care Fraud and Abuse Control Program (the “Program”). The report highlights the...more

DOJ Recovers Up To $48 Million in False Claim Act Case Resulting From Whistleblower Report

In yet another large recovery for the DOJ, on December 6, 2012, DFB Pharmaceuticals, and its subsidiary, Healthpoint Ltd., agreed as part of a settlement to pay up to $48 million to resolve allegations that Healthpoint caused...more

The False Claims Act and Healthcare Providers: Key Results from 2012 and Likely Trends for 2013

From the perspective of False Claims Act (FCA) results, 2012 was a decidedly mixed year for healthcare providers. The bad news was quite bad—increased FCA scrutiny by the Department of Justice (DOJ) led to $3 billion of...more

Navigating the Provider Self-Disclosure Protocol

Providers can voluntarily disclose potential fraud with respect to Federal health care programs — Medicare, Medicaid, and potentially private insurers to the extent Federal or state funds are involved — by following the...more

Private Health Insurance Efforts To Fight Fraud

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

Record Healthcare Fraud Recovery Calls for Compliance

To date in 2012, the Department of Justice secured a record $3.3 billion in settlements and judgments in civil cases alleging healthcare fraud against the government under the Federal False Claims Act (“FCA”). The figure,...more

Who is Committing Healthcare Fraud?

The financial recoveries for healthcare fraud are staggering. The Justice Department and Health and Human Services (Office of Inspector General (“OIG”) and Centers for Medicare and Medicaid Services (“CMS”)) regularly...more

Targeting Healthcare Fraud by Data Mining

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

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