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Fraud False Claims Act (FCA) Hospitals

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Robinson+Cole Health Law Diagnosis

Connecticut Expands Applicability of State False Claims Act

On June 26, 2023, Connecticut Governor Ned Lamont signed into law Public Act 23-129: “An Act Concerning Liability for False and Fraudulent Claims” (the Act). The Act expands application of Connecticut’s False Claims Act...more

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | March 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for March 2023. We discuss several criminal and civil enforcement actions that involve Anti-Kickback Statute (AKS) and...more

Smith Gambrell Russell

How A Hospital Can Assure That It Will Be Required To Pay Punitive Damages

Smith Gambrell Russell on

During the federal fiscal year ending in September, 2022, the Department of Justice collected more than $1.7 billion in False Claims Act (FCA) settlements and judgments involving fraud in Medicaid, Medicare Advantage (MA)...more

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | January 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity and developments occurring in January 2023, including several criminal and civil enforcement actions related to the federal...more

Gardner Law

Anti-Fraud & Sunshine Update

Gardner Law on

Staying up-to-date with fraud enforcement trends and recent cases and settlements can sometimes be viewed as a “Glass Half Empty” perspective, focusing on negative aspects of the industry and the perceived threat of...more

Bass, Berry & Sims PLC

2021 Recap: Hospitals’ Significant False Claims Act Settlements

Bass, Berry & Sims PLC on

Each year, the Department of Justice (DOJ) recovers millions of dollars through False Claims Act (FCA) settlements, and 2021 was no exception. Some of the most sizeable or otherwise noteworthy settlements from 2021 were with...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

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 25. News Briefs: July 2020

Report on Medicare Compliance 29, no. 25 (July 13, 2020)  -  Ophthalmic Consultants PA in Sarasota, Florida, agreed to pay $4.8 million to settle false claims allegations that it billed Medicare and other federal payers...more

King & Spalding

Ninth Circuit Holds That Medical Opinions Do Not Automatically Preclude FCA Liability at the Pleading Stage

King & Spalding on

In late March, the United States Court of Appeals for the Ninth Circuit revived a whistleblower lawsuit under the False Claims Act (FCA) in which a former employee accused a healthcare provider of submitting reimbursement...more

Dorsey & Whitney LLP

Escobar in Action: Physician-owners’ fraud claims against hospital defeated in Fifth Circuit appeal for lack of materiality

Dorsey & Whitney LLP on

Following the passage of the Affordable Care Act (“ACA”), which placed new limits on physician-owned hospitals, St. Luke’s Health System (“System”) took action to change one of its hospital’s ownership structures through a...more

ArentFox Schiff

Investigations Newsletter: 34 Individuals Charged in $258 Million Medicare and Medicaid Fraud Schemes

ArentFox Schiff on

34 Individuals Charged in $258 Million Medicare and Medicaid Fraud Schemes - Twenty-six individuals in the state of California, fourteen of whom were doctors or medical professionals, and eight individuals in Arizona and...more

Manatt, Phelps & Phillips, LLP

Health Update - November 2017

Fraud and Abuse 2017: Understanding Trends and Avoiding Actions - Editor’s Note: In a recent webinar for Bloomberg BNA, Manatt examined game-changing fraud and abuse trends and cases—and revealed strategies for avoiding...more

Bass, Berry & Sims PLC

FCA Deeper Dive: Pleading the Alleged Fraud Scheme

Bass, Berry & Sims PLC on

The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we are...more

Mintz - Health Care Viewpoints

Another Court Agrees That A Difference Of Opinion On Medical Necessity Is Insufficient to Show Falsity Under the False Claims Act

Last month, the U.S. District Court for the District of Utah joined the AseraCare court and others in finding that a relator cannot successfully allege violations of the False Claims Act (“FCA”) based on a purported lack of...more

Snell & Wilmer

You’re Fired: What Impact Will Sally Yates’ Departure Have on the DOJ’s Fraud Enforcement?

Snell & Wilmer on

As most of the world now knows, President Trump fired acting Attorney General Sally Yates last week after she declined to defend the President’s travel ban. Dana Boente has replaced Ms. Yates, but he may not be long for the...more

The Volkov Law Group

Tenet Healthcare Settles Fraud Case for $514 Million

The Volkov Law Group on

If you work in compliance in the healthcare industry, you have a tough job. The number and variety of risks that healthcare providers face is daunting. The False Claims Act is a mighty weapon in the hands of federal...more

Bond Schoeneck & King PLLC

Health Law Wire: US Department Of Justice Chief For The Criminal Division, Leslie R. Caldwell Stresses The Importance Of Effective...

DOJ’s Chief in charge of Criminal Prosecutions has been vocal on increased civil and criminal enforcement efforts. Over the past few months, the US Department of Justice has heightened its enforcement in health fraud matters...more

Proskauer - Government Contractor Compliance...

Proskauer Obtains Dismissal of High-Stakes False Claims Act Suit

On August 7, 2014, Judge Castel of the Southern District of New York dismissed a False Claims Act (“FCA”) complaint that was based primarily on allegations that the defendant Hospital improperly focused on referral revenue in...more

Akin Gump Strauss Hauer & Feld LLP

Los Angeles County Sues Hospital Owner for False Surgical Implant Claims to County Workers’ Compensation Program

On July 18, 2014, the County of Los Angeles (“the County”) filed a lawsuit in Los Angeles Superior Court again Michael D. Drobot, Sr., his son Michael R. Drobot, Jr. and their controlled entities, Pacific Hospital of Long...more

Faegre Drinker Biddle & Reath LLP

Halifax Health Gets In More Hot Water

You probably didn’t think Florida’s Halifax Health could make its situation any worse. After all, only two months ago Halifax agreed to pay $85 million to settle just the first half of a Medicare fraud case. That still...more

Mintz - Health Care Viewpoints

Serial Relator Getting the Boot?

This past Friday, hospital company HCA Holdings, Inc. asked a federal court judge to dismiss a False Claims Act (FCA) suit filed by whistleblower and former employee, Stephen McMullen. Mr. McMullen worked for an...more

King & Spalding

Judge Approves Two-Year Delayed Prosecution of WakeMed

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A Federal district court judge issued a February 8, 2013 order granting a delayed prosecution against Raleigh, NC-based WakeMed Health and Hospitals for allegedly submitting false inpatient bills to Medicare. The...more

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