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False Claims Act (FCA) › Data Mining

Arnall Golden Gregory LLP

Seventh Circuit Affirms Liability in AKS-Based FCA Suit But Vacates Award of Damages

Arnall Golden Gregory LLP on

The United States Court of Appeals for the Seventh Circuit recently considered a district court’s nearly $6 million judgment in a qui tam False Claims Act (“FCA”) suit based on Anti-Kickback Statute (“AKS”) violations. The...more

Mintz

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

Mintz on

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

Foley & Lardner LLP

Health-Care Fraud Scrutiny Heats Up For Companies, Providers

Foley & Lardner LLP on

This year will see a continued proliferation of enforcement against health-care fraud, with old and new theories. Some hot spots for enforcement will involve cases about new technologies; data outliers; entities perceived as...more

King & Spalding

DOJ Alleges Kaiser Defrauded Medicare Out of $1 Billion

King & Spalding on

On October 25, 2021, DOJ intervened in a False Claims Act (FCA) case against Kaiser Permanente, Kaiser Foundation Health Plan, Inc., and certain Permanente Medical Groups (Kaiser). In its complaint, DOJ contends that Kaiser...more

Amundsen Davis LLC

Payment For Access To Patient Data May Be A Violation Of The AKS

Amundsen Davis LLC on

Northern District of Illinois recently found that a home health care company violated the federal Anti-Kickback Statute (AKS) because the fees it paid to a community care organization for access to that company’s patient data...more

Maynard Nexsen

New Kid on the Block: The Rise of the Data Mining Whistleblower

Maynard Nexsen on

This article is the first in a series of three that will explore the topic of data mining and its ability to highlight potential healthcare fraud, as well as its effects on healthcare systems and medical providers.Data mining...more

Polsinelli

Proposed Rule to Strengthen State Medicaid Fraud Control Units

Polsinelli on

A recently published proposed rule expands the functions and responsibilities of state Medicaid Fraud Control Units (MFCUs). The rule was issued by the Centers for Medicare and Medicaid Services (CMS) and the Office of...more

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