News & Analysis as of

Fraud False Billing

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
ArentFox Schiff

Investigations Newsletter: DOJ Announces Agreement With Rite Aid to Settle Allegations of Violating the FCA and CSA in Relation to...

ArentFox Schiff on

DOJ Announces Agreement With Rite Aid to Settle Allegations of Violating the FCA and CSA in Relation to Opioid Dispensing - On July 10, the US Department of Justice (DOJ) announced that Rite Aid Corporation and 10 of its...more

Harris Beach PLLC

False Claims Act Enforcement Highlights Need for Robust Compliance Programs

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The U.S. Department of Justice (“DOJ”) announced its False Claims Act (“FCA”) enforcement statistics for FY 2023 and identified key priorities for FCA enforcement in 2024 and beyond. The DOJ continues to pursue FCA...more

ArentFox Schiff

Investigations Newsletter: Former Healthcare Executives Convicted for Health Insurance Policy Fraud Scheme

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Former Healthcare Executives Convicted for Health Insurance Policy Fraud Scheme - Steven Dorfman, the former chief executive officer and owner of the Florida-based healthcare company Simple Health, and John Sand, a former...more

Rivkin Radler LLP

CT Psychologists Convicted for Medicaid Fraud

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On December 19, Michael Lonski, a Greenwich psychologist, was sentenced to a 27-month prison term and three more years of supervised release for a scheme to defraud Medicaid. Lonski submitted over 80,000 claims from 2014 to...more

Maynard Nexsen

Recent FCA Settlement Highlights Small Business Certification Issues in Private Equity Transactions

Maynard Nexsen on

The Department of Justice ("DOJ") recently announced a $1.75 million false claims settlement with a contractor that "improperly obtained government contracts that were set-aside for small businesses." The DOJ settlement...more

Bradley Arant Boult Cummings LLP

Government Contractor Booz Allen Hamilton Enters One of the Largest Procurement Fraud Settlements with DOJ over FCA Allegations

On Friday, July 21, 2023, DOJ announced it has reached a $377,453,150 settlement with Booz Allen Hamilton Holding Corporation (Booz Allen), the parent company of Booz Allen Hamilton, Inc., the large government and military...more

Kerr Russell

Did I Commit Fraud?

Kerr Russell on

Question: I am under audit by a dental plan I participate with. The audit has identified a few issues in connection with how my billing employees have been submitting claims for payment. For example, the name of the treating...more

Rivkin Radler LLP

Fraud Week: NY Transportation Company Owners Jailed, Fined

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Transportation fraud isn’t new, but it’s new to Rivkin Rounds. The U.S. Attorney’s Office for the Southern District of New York recently announced that Yonkers resident Julio Alvarado was sentenced to 95 months in prison for...more

Rivkin Radler LLP

Fraud Week: DOJ Announces COVID-Related Fraud Sweep

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The U.S. Department of Justice (DOJ) announced on April 20 that it has brought criminal charges against 18 defendants across the U.S. for various fraud schemes related to the COVID-19 pandemic. The DOJ seized more than $16...more

Bass, Berry & Sims PLC

Recap of Webinar: Billing, Coding, and Collecting for Infusion Services

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Bass, Berry & Sims attorney Shannon Wiley, with Carine Leslie and Katie Garmon of PYA, P.C., recently discussed the complexities associated with billing, coding, and collecting for infusion services as part of the Infusion...more

Mintz - Health Care Viewpoints

EnforceMintz — With Telemedicine Here to Stay, Enforcement Agencies Continued their Scrutiny

The Department of Justice and other federal enforcement agencies continued to hotly pursue individuals and entities involved in criminal telefraud schemes in 2022, as evidenced by the national coordinated law enforcement...more

Hendershot Cowart P.C.

Healthcare Providers: You May Be Liable for Billing Company Fraud, Negligence

Hendershot Cowart P.C. on

Physicians and practice managers: Keep an eye on medical billing or health services contractors acting on your behalf. Your practice is liable for any violations of state and federal healthcare fraud laws, including Stark...more

Rivkin Radler LLP

Connecticut Doctor Pleads Guilty to Fraud and Kickbacks

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The U.S. Attorney’s Office for the District of Connecticut announced on November 3 that Ananthakumar Thillainathan, a physician with offices in Stratford and Milford, pleaded guilty to healthcare fraud and federal kickback...more

Rivkin Radler LLP

Fraud Week: NY Chiropractor Billed for Non-Existent Acupuncture Services

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On August 15, the U.S. Department of Justice (DOJ) announced that a Long Island chiropractor pleaded guilty to healthcare fraud for billing a private insurance company over $1 million for acupuncture services that were never...more

Rivkin Radler LLP

Private Insurers Must Watch Out for Medical Equipment Fraud

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Healthcare fraud related to durable medical equipment (DME) is extremely costly to insurers yet often continues without criminal or civil consequences. Fraudulent schemes by DME supply companies vary in complexity but...more

Fox Rothschild LLP

COVID-19 Fraud Enforcement Task Force Cracks Down on Pandemic-Related Fraud

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In May 2021, Attorney General Merrick Garland announced the creation of the COVID-19 Fraud Enforcement Task Force. The Task Force is comprised of more than a dozen federal agencies that are investigating and prosecuting...more

Wiley Rein LLP

Supreme Court to Consider DOJ’s Dismissal Authority in False Claims Act Qui Tam Cases

Wiley Rein LLP on

What: The U.S. Supreme Court recently granted certiorari on a petition seeking to curtail the U.S. Department of Justice’s (DOJ) ability to dismiss False Claims Act (FCA) qui tam cases, even if DOJ has determined that the...more

Fox Rothschild LLP

US Launches Nationwide Coordinated Law Enforcement Action to Combat Health Care-Related COVID-19 Fraud

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As part of its ongoing effort to crack down on health care-related COVID-19 fraud, the U.S. Justice Department has launched a nationwide coordinated law enforcement action that recently led to criminal charges against 21...more

Rivkin Radler LLP

21 Charged in Federal COVID-19 Fraud Sweep

Rivkin Radler LLP on

On April 20, the U.S. Department of Justice (DOJ) announced criminal charges against 21 people across the country for COVID-19-related frauds. The defendants are accused of over $149 million in false billings to federal...more

King & Spalding

COVID-19 Health Care Fraud Enforcement on the Rise: What’s Ahead for the Life Sciences & Healthcare Industries

King & Spalding on

On April 20, 2022, the Department of Justice (“DOJ”) announced twenty-one (21) defendants were charged in nine (9) different districts related to $149 million in COVID-19-related false billing issues. $8 million in cash and...more

ArentFox Schiff

DOJ Brings Charges Against 21 People in $150 Million COVID-19 Fraud Action

ArentFox Schiff on

The DOJ announced charges against 21 people across nine federal districts for their alleged role in pandemic-related fraud schemes resulting in over $149 million in false billings to federal programs. This is the largest...more

Dorsey & Whitney LLP

Home-Health Services Company Settles After Allegations of Double-Billing Scheme

Dorsey & Whitney LLP on

The Department of Justice recently announced that a home-health services company has agreed to pay over $45,000 to resolve alleged False Claims Act (“FCA”) violations. Professional Family Care Services, Inc. (“PFCS”), a North...more

Wiley Rein LLP

2021 FCA Recoveries Bounce Back from Decade-Low . . . Maybe

Wiley Rein LLP on

On February 1, the U.S. Department of Justice (DOJ) announced the second-largest annual total recoveries in the history of the False Claims Act (FCA)—$5.6 billion—for FY 2021 (October 2020 – September 2021)...more

ArentFox Schiff

Texas Hospital to Pay Over $3 Million to Resolve False Claims Act Allegations

ArentFox Schiff on

John Peter Smith Hospital (JPS) agreed to pay more than $3.3 million to settle allegations that it violated the False Claims Act by upcoding hundreds of claims submitted to federal healthcare programs. Texas Hospital to...more

Jones Day

Federal Court of Appeals Emphasizes Only Defendants Who Act "Knowingly" Can Be Liable Under the False Claims Act

Jones Day on

A recent split decision from the United States Court of Appeals for the Seventh Circuit strengthens an argument many defendants of False Claims Act ("FCA") cases have been advancing for years: the violation of an ambiguous...more

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