News & Analysis as of

Fraud Medicaid

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

The State AG Report Weekly Update

by Cozen O'Connor on

Breaking News- Arkansas Attorney General Is New Chairman of Republican Attorneys General Association- Earlier today, the Republican Attorneys General Association (“RAGA”) named Arkansas AG Leslie Rutledge as its new...more

First Look at OIG’s FY 2017 Fraud Recoveries/Enforcement Activities

by Reed Smith on

The HHS Office of Inspector General (OIG) expects its investigative recoveries during the first half of fiscal year (FY) 2017 to top $2.04 billion – which is down from $2.77 billion for the first half of FY 2016. During this...more

Twelve-Year Sentence for Medicaid Diaper Scam

by Faegre Baker Daniels on

Maria Paz Garza was the King Midas of incontinence supplies: she turned diapers into dollars—over two and a half million of them, according to the government’s indictment. She did it through a scheme that charged Texas...more

OIG Issues FY 2016 Annual Report of the Medicaid Fraud Control Units

by Arnall Golden Gregory LLP on

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) issued the Medicaid Fraud Control Units Fiscal Year 2016 Annual Report in May 2017. The Annual Report is based on analysis of statistical...more

New York Man Sentenced To 10 Years In Prison For Involvement In $26 Million “Billing Mill”

by Fox Rothschild LLP on

Last month, a New York man was sentenced to 10 years in prison for allegedly operating a $26 million scheme to defraud Medicare and Medicaid. The defendant allegedly established 6 medical clinics in Brooklyn that paid elderly...more

The State AG Report Weekly Update April 27, 2017

by Cozen O'Connor on

Breaking News - Cozen O’Connor’s State AG Practice Co-Chair Lori Kalani Interviews Massachusetts Attorney General - Cozen O’Connor’s State Attorneys General Practice Co-Chair Lori Kalani recently interviewed...more

OIG Releases FY 2016 Statistical Data About Medicaid Fraud Control Units

Earlier this week, the Office of Inspector General for the Department of Health and Human Services (“OIG”) posted its fiscal year (“FY”) 2016 data about Medicaid Fraud Control Units (“MFCUs”) across the country....more

This Month in Corruption: the Same Old Saga Continues

by PretiFlaherty on

As a faithful reader of the State House News Service, I have been noticing for years how often the Press Releases section of the service’s subscriber-only web site contains an account of wrongdoing and/or unsavory behavior in...more

2016 Nerve-of-a-Burglar Award

by Faegre Baker Daniels on

Competition for the 2016 Nerve-of-a-Burglar Award was fierce, with health care providers constantly coming up with new and different ways to scam Medicare and Medicaid. Nevertheless, we have a clear winner: the Michigan...more

This Month in Corruption: Snapshots of the Public Trust Betrayed

by PretiFlaherty on

If I were back in the newspaper business, I’d probably write a lead for this article with the cliché that “crime never takes a holiday.” Yes, clichés are the first resort of lazy scribes, but the good thing is, they are...more

Universities Are Prime Targets for False Claims Act Liability

by McCarter & English, LLP on

Colleges and universities receive billions of dollars in federal funds, whether through research grants or student financial aid, or even by billing Medicare or Medicaid for services rendered at academic medical centers. As a...more

OIG “Investigative Advisory” Highlights Potential Medicaid Fraud, Patient Harm Stemming from Personal Care Services

by Reed Smith on

The OIG has issued an “Investigative Advisory on Medicaid Fraud and Patient Harm Involving Personal Care Services” that identifies various “fraud schemes” it has encountered involving personal care services (PCS) — nonmedical...more

Tenet Healthcare Settles Fraud Case for $514 Million

by Michael Volkov 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

CMS and OIG Propose First Major Medicaid Fraud Control Program Changes Since 1978

by King & Spalding on

On September 20, 2016, CMS and the OIG jointly published a proposed rule, available here, to amend the largely unchanged 1978 regulation governing State Medicaid Fraud Control Units (MFCUs). Since the initial issuance of the...more

HHS Proposes Changes to State Medicaid Fraud Control Unit Rules

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have proposed amendments to the regulations governing State Medicaid Fraud Control Units (MFCUs). The proposed rule would reflect...more

What’s In a Name? Or, the Importance of Emphasis

by Faegre Baker Daniels on

I.A. Khair of New Jersey ran an ambulance company called K&S Invalid Coach. Presumably, “Invalid” was pronounced IN-va-lid, with the emphasis on the first syllable. Maybe it should have been pronounced in-VAL-id, with the...more

Materiality Is the New Condition of Payment: The Implied False Certification Theory After Escobar

by Pepper Hamilton LLP on

The Supreme Court has made it clear that, even at the pleadings stage, relators (or the government) must plead facts to support materiality with plausibility and particularity. For False Claims Act (FCA) defendants who...more

SCOTUS Gives Fed Contractors Mixed Bag

by Sherman & Howard L.L.C. on

Last week the U.S. Supreme Court issued an opinion that refines and re-defines liability for contractors accused of defrauding the Federal Government under the False Claims Act (“FCA”) in Universal Health Services, Inc. v....more

Supreme Court ruling potentially expands false claims liability for healthcare providers

by McAfee & Taft on

In a much-anticipated decision, the U.S. Supreme Court ruled recently that the implied false certification theory may form the basis for liability under the False Claims Act (FCA), resolving a split of among the federal...more

Supreme Court Case Expands False Claims Act Liability

by Hinshaw & Culbertson LLP on

Summary of Decision - On June 16, 2016, the United States Supreme Court decided a case which could have significant impact on healthcare providers. In Universal Health Services Inc. v Escobar, the Court expanded...more

Universal Health Services v. Escobar

by King & Spalding on

On Thursday of last week, the Supreme Court for the first time addressed the “implied certification” theory of liability under the False Claims Act. The Court ruled unanimously that the theory is valid in certain...more

Supreme Court Adopts Implied False Certification Theory in Universal Health Services v. United States ex rel. Escobar But Imposes...

by Mintz Levin on

On June 16, 2016, a unanimous Supreme Court issued its long-awaited decision in Universal Health Services v. United States ex rel. Escobar (“Escobar”). The Court ruled that under certain circumstances the theory of “implied...more

"In Escobar, Supreme Court Upholds False Claims Act’s Implied Certification Theory"

On June 16, 2016, the U.S. Supreme Court in Universal Health Services v. United States ex rel. Escobar unanimously upheld the implied certification theory of False Claims Act (FCA) liability. The Court ruled that a party can...more

The Supreme Court Adopts Broad Scope of False Claims Act Liability

A unanimous Supreme Court issued its long-awaited and closely watched decision today on the scope of the False Claims Act (“FCA”), and the Court affirmed the FCA’s long reach. Universal Health Services, Inc. v. United States...more

Pennsylvania’s Proposed False Claims Act: Why Further Incentivizing Whistleblowers Is Unnecessary, Counterproductive, and Could...

by K&L Gates LLP on

As Pennsylvania legislators work to resolve the budget impasse, proponents of enacting a Pennsylvania False Claims Act (“PA FCA”) targeting Medicaid continue to intensify their efforts in Harrisburg. Legislators may consider...more

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