Fraud and Abuse

News & Analysis as of

Specialty Pharmacy Per-fill Fee Rejected by OIG

On August 15, 2014, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued a “negative” opinion regarding a specialty pharmacy’s proposal to pay a per-fill fee to local pharmacies for support...more

Managing the announcement of a Department of Education Program Review

Following the initial release of the well-known and controversial 2010 GAO report concerning alleged abuses in the for-profit sector, Secretary of Education Arne Duncan issued a public letter to Senators Tom Harkin and Mike...more

Summer Fraud and Abuse Roundup

The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to...more

OIG Finds Risk of Abuse in Specialty Pharmacy’s Per-Fill Fee Proposal

In an Advisory Opinion posted August 15, 2014, the Office of Inspector General (“OIG”) concluded that a proposed arrangement by a specialty pharmacy (“Requestor”) might generate prohibited remuneration under the Federal...more

Laboratory Payments to Physicians for Specimen Processing Present Substantial Risk of Fraud and Abuse

The United States Office of Inspector General (“OIG”) recently issued a “Special Fraud Alert” focusing on two potentially illegal trends that it has detected in arrangements between laboratories and their referring...more

What to Do When an Investigator Comes Knocking

Our firm has observed a significant uptick in the investigation of government contractors in the last few years. This is driven, in large part, by a political and regulatory environment that assumes fraud, waste and abuse are...more

OIG Issues Special Fraud Alert on Laboratory Payments to Referring Physicians

The Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services recently issued a Special Fraud Alert (“Alert”) that addresses two types of arrangements that the OIG believes pose a substantial...more

CFPB Sues Debt Collection Law Firm

On July 14, the CFPB sued a Georgia-based law firm and its three principal partners for allegedly using high-volume litigation tactics to collect millions of dollars from consumers who may not actually have owed the debts or...more

Congress Scrutinizes Hedge Funds’ Use of Financial Derivatives

This week the Senate Permanent Subcommittee on Investigations, Committee on Homeland Security and Governmental Affairs (Subcommittee), in conjunction with the Subcommittee’s hearing on July 22, 2014, released a report on...more

US govt. spent $100B in improper payments | Governmental Mismanagement?

If you’re an American taxpayer, I have some bad news for you. According to recent reports by federal agencies, $100 billion in payments were made last year to people who may not have been supposed to receive them....more

An Ounce of Fraud Prevention Is Worth Trillions of Dollars

A recent study, Report to the Nations on Occupational Fraud and Abuse: 2014 Global Fraud Study from the Association of Certified Fraud Examiners (ACFE) analyzed nearly 1,500 cases of occupational fraud as reported the...more

Is $210 Million Enough? How About $54.2 Million?

On June 25, 2014, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services Office of Inspector General (OIG) issued and certified, as required by the Small Business Jobs Act of 2010...more

Brace for Medicaid data mining and recoupment demands

The federal Health and Human Services Office of Inspector General (OIG) is escalating its war against Medicaid fraud and abuse, just as it has over the past years with Medicare. The OIG’s focus has turned to early prevention...more

OIG Revamps Regulations Concerning CMPs and Exclusion

In a pair of proposed rules published in May, the HHS OIG unveiled changes to the regulations concerning OIG’s authority to impose civil monetary penalties (CMPs) and exclude individuals and entities from participation in...more

HHS OIG Releases Proposed Rules Regarding Increased Authority to Combat Fraud and Abuse under the ACA

The Office of Inspector General (OIG) of the Department of Health and Human Services proposed two new rules last week in order to expand its enforcement authority, implementing changes adopted as part of the Patient...more

Updated E-Filing Requirements for Tax Preparers

In the IRS's point of view, preventing fraud and abuse of the electronic filing system is the shared responsibility of both the IRS and authorized e-file providers. In an effort to stop the fraud, abuse, and resulting...more

Lifeline Database Update: NLAD Operational in All States, FCC Announces Success

The FCC’s National Lifeline Accountability Database (“NLAD”) now is operational in all states and has already had a significant impact in reducing waste, fraud, and abuse. The FCC announced today that, so far, the NLAD has...more

Illinois AG Sues To Enforce Dodd-Frank “Abusive” Prohibition

On March 19, Illinois Attorney General (AG) Lisa Madigan announced a suit against a lender for allegedly offering a short-term credit product designed to evade the state’s usury cap. The AG claims the lender offers a...more

"OECD Outlines Plans to Prevent Double-Tax Treaty Abuse"

On March 14, 2014, the Organisation for Economic Co-operation and Development (OECD) published a discussion draft report on preventing double-tax treaty abuse (the Treaty Report). The OECD supplemented this release on March...more

Part II: Exploration of Common Exceptions to the Stark Law

In this Presentation: Kristin Cilento Carter presented “Exploration of Common Exceptions to the Stark Law” as part of the program “Stark Physician Self-Referral Law,” an installment in the Fraud and Abuse Basics...more

Blow Your Green Whistle to Protect the Environment

The Office of Inspector General is an independent office within the U.S. Environmental Protection Agency (EPA) that assists the agency in accomplishing its goals more efficiently. OIG conducts audits, investigations and...more

Trade group criticizes CFPB reliance on enforcement and informal guidance

The U.S. Chamber of Commerce’s Center for Capital Markets Competitiveness has sent a detailed letter to Director Cordray in which it criticizes the CFPB’s approach of “regulation by enforcement settlement combined with...more

Office of Management and Budget (OMB) Reviewing Two Proposed Fraud & Abuse Rules

On February 5, 2014, the OMB received two proposed rules from the Department of Health and Human Services Office of the Inspector General (OIG). One proposed rule would, among other things, update OIG’s regulations to...more

OIG's 2014 Work Plan: A Roadmap to Key OIG Fraud and Abuse Priorities

The Department of Health and Human Services, Office of the Inspector General (OIG) released its Fiscal Year (FY) 2014 Work Plan on January 31, 2014. While the OIG usually releases its work plan in October of each year, in...more

OIG Plans to Fight Fraud, Waste, and Abuse While Promoting Quality, Safety, and Value in 2014

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Work Plan for Fiscal Year 2014 on January 31, 2014. The Work Plan provides insight into the OIG’s priorities by providing...more

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