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False Statements Medicare False Claims Act (FCA)

Harris Beach PLLC

OIG January 2024 Enforcement Summary

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The following is a summary of selected federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported...more

Snell & Wilmer

Scope of FCA Liability Illustrated In Recent Actions Against Higher Education Institutions

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In the past five years, the Federal Government and “Qui Tam” Realtors have ramped up False Claims Act (“FCA”) actions against higher education institutions. These actions highlight the scope and breadth of potential FCA...more

Akerman LLP - Health Law Rx

Teva FCA Decision Sheds Light on Varying Interpretations of the Elements of an FCA Claim

How could alleged kickbacks threaten to render insolvent a publicly traded company with assets (taken from its latest SEC filing) in excess of $43 billion? The answer stems from a recent decision by the United States District...more

ArentFox Schiff

Investigations Newsletter: $31 Million Medicare Fraud Scheme Results in Two Convictions

ArentFox Schiff on

$31 Million Medicare Fraud Scheme Results in Two Convictions - On January 30, 2023, a federal jury found two Florida physicians guilty for their involvement in a scheme to defraud Medicare of over $31 million. The two...more

ArentFox Schiff

Investigations Newsletter: COVID-19 Fraud Update: DOJ Prosecutes More than 150 Defendants, 95 Criminal Cases

ArentFox Schiff on

COVID-19 Fraud Update: DOJ Prosecutes More than 150 Defendants, 95 Criminal Cases - Since the inception of the CARES Act, DOJ’s Fraud Section has prosecuted over 150 defendants in over 95 criminal cases. The Fraud Section...more

ArentFox Schiff

Investigations Newsletter: California Man Convicted in $27 Million PPP Fraud Scheme

ArentFox Schiff on

California Man Convicted in $27 Million PPP Fraud Scheme - After a trial before a federal jury, a California man was convicted of bank fraud, making false statements to a financial institution, and money laundering for...more

ArentFox Schiff

Investigations Newsletter: Contractor to Pay Over $4 Million to Settle FCA Violations

ArentFox Schiff on

CEO of Defunct Medical Testing Lab to Pay $1.1 Million to Settle FCA and AKS Case - Jae Lee, the former CEO of defunct Northwest Physicians Laboratory (NWPL), agreed to pay $1.1 million to resolve allegations that he...more

ArentFox Schiff

Investigations Newsletter: Texas Man Charged for Allegedly Filing False PPP Loan Applications

ArentFox Schiff on

COVID Relief Program Fraud Charges - DOJ continues to announce charges against defendants accused of fraud in connection with allegedly false loan applications submitted under the Paycheck Protection Program (PPP)...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 3. News Briefs: January 2020 #3

Report on Medicare Compliance 29, no. 3 (January 27, 2020) - Mission, Texas, rheumatologist Jorge Zamora-Quezada, M.D., was found guilty by a jury Jan. 15 for his part in a $325 million heath fraud scheme in which he...more

Butler Snow LLP

Pro Te: Solutio – Vol. 12, No. 3

Butler Snow LLP on

Summer is winding down, and Fall texted to say she is on her way. This means that Pro Te: Solutio is returning for its third edition of 2019. As always, our authors have taken the time to research and address current issues...more

McDermott Will & Emery

Eighth Circuit Rejects FCA Claim for Failure to Allege Actual Claims for Payment

McDermott Will & Emery on

On February 11, 2019, the Eighth Circuit affirmed the dismissal of a group of relators’ qui tam suit against Crawford County Memorial Hospital for failure to meet the pleading standards required by Federal Rule of Civil...more

Saul Ewing LLP

Sixth and Tenth Circuits Rule that Medical Statements Are Capable of Falsehood Under the FCA

Saul Ewing LLP on

Two recent False Claims Act (FCA) decisions – United States v. Paulus, 894 F.3d 267 (6th Cir. 2018) and United States ex rel. Polukoff v. St. Mark’s Hospital, 895 F.3d 730 (10th Cir. 2018) – establish that an FCA claim can be...more

Holland & Knight LLP

Healthcare Law Update: September 2017

Holland & Knight LLP on

OIG Advisory Opinions - Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized - On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more

Pillsbury Winthrop Shaw Pittman LLP

A “Change of Heart” in a Health Care Fraud Prosecution - Inconsistent angiogram interpretations establish reasonable doubt in...

On March 7, 2017, the U.S. District Court for the Eastern District of Kentucky reversed the October 27, 2016 criminal jury verdict against Kentucky cardiologist Dr. Richard E. Paulus, and acquitted him on all counts of health...more

Mintz

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: December 2015

Mintz on

Trends & Analysis - We have identified 24 health care–related qui tam cases that have been unsealed since our last Qui Tam Update. Of the 24 cases, five were filed within the past year, seven were filed in 2014, three...more

Manatt, Phelps & Phillips, LLP

Corporate Investigations & White Collar Defense - October 2015

"Wherefore Art Thou Due Process?" Part III - Why it matters: It is time for another installment in our continuing "Wherefore Art Thou Due Process?" coverage into the ongoing constitutional challenges to the SEC's...more

Baker Donelson

Deferred Prosecution Agreements: How an Effective Compliance Program Can Help You Plan for the Unpredictable

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During the past several years, prosecutors have increasingly used Deferred Prosecution Agreements (DPAs) against corporations in enforcing white collar criminal statutes. DPAs have enabled companies to avoid the costs and...more

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