Healthcare Fraud

News & Analysis as of

HEB Grocery Company Agrees to Pay $12 Million to Settle Texas Medicaid Fraud

On March 17, 2014, a Texas state court dismissed a qui tam lawsuit against HEB Grocery Co. after HEB reach an agreement with the Texas Attorney General’s Civil Medicaid Fraud Division to pay a combined $12 million to settle...more

AMS Facing Healthcare Fraud Investigation by California Attorney General

In 2011 Endo Health Solutions bought American Medical Systems for $2.9 billion. That may have been a mistake because since then, the number of product liability lawsuits naming AMS over its transvaginal mesh has grown to...more

Seeing Dollar Signs: U.S. Settles with Ophthalmologist for $1.4 Million to Resolve FCA Claims

Last week, the United States settled with a Baltimore ophthalmologist for alleged violations of the False Claims Act (“FCA”). Pursuant to the settlement, the ophthalmologist, Dr. John Arthur Kiely, agreed to pay $1.4 million...more

Program Integrity Priorities Revealed in FY 2015 HHS Budget

On March 14, 2014, President Obama unveiled his Administration’s proposed fiscal year 2015 budget for the Department of Health and Human Services (HHS). In total, the Administration is seeking $77.1 billion to fund HHS in FY...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

FY 2015 Budget Request Includes Reductions and Reforms to CMS Spending

President Obama has released the administration’s FY 2015 budget request, and it includes investments and proposals for HHS that are estimated to save $355.6 billion over 10 years. The FY 2015 budget estimate for CMS is...more

OIG Releases Report on Medicaid Fraud Control Units

The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2013 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCU)...more

Update: Federal Government Aggressively Pursuing Health Care Fraud

The July 2013 alert, Federal Government Aggressively Pursuing Health Care Fraud, stressed the importance of self-audits for health care providers. With the Obama administration taking a hard-line approach to repeat offenders...more

White Collar Watch - February 2014

Contents - False Claims Act ruling opens door to large damage awards... pages 1 - 2 - Supreme Court asked if state universities are exempt from liability under the False Claims Act... pages 2 - 4 -...more

Rx for Fraud: Electronic Health Records

By pursuing a mandate to digitize medical records, the federal government hopes to improve patient care and reduce costs. But recent reports by the Office of the Inspector General (OIG) indicate that fraud prevention policies...more

The Louisiana Supreme Court's Decision In Caldwell v. Janssen And The Broader Implications

On January 28, 2014, the Supreme Court of Louisiana set aside a judgment of $257 million in civil penalties that a lower court had entered in favor of the state against Janssen under the Louisiana Medicaid false claims act,...more

Short Wins - A Dog's Breakfast Of Victories

It's a grab bag of victories in the federal circuits for last week. A few sentencing remands - including one based on a loss calculation in a health care fraud case - but the most interesting remand is in the First Circuit's...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

The Strike Force Approach To Combatting Health Care Fraud

The U.S. Department of Justice (DOJ), Health and Human Services Office of Inspector General (HHS-OIG) and other federal and state agencies are aggressively prosecuting health care fraud and related offenses through a strike...more

Kickbacks, Misbranding and Criminal Accusations: Johnson & Johnson Agrees to Pay $2.2 Billion to End Investigations

The once-trusted healthcare products giant Johnson & Johnson entered into an agreement in November with the U.S. Department of Justice to pay one of the largest healthcare fraud settlements in U.S. history. ...more

Health Care Self-Disclosure Protocols – Is It Worth It To Self-Report?

In recent years the federal government has aggressively investigated and prosecuted pharmaceutical companies and health care providers for possible violations of anti-fraud, anti-kickback and other laws. These efforts have...more

Healthcare Enforcement Actions and Trends: 2013 Overview

The Department of Justice (DOJ) and the Office of Inspector General for the U.S. Department of Health and Human Services continued aggressive enforcement of the healthcare industry in 2013. Officials employed a variety of...more

OIG Releases 2014 Work Plan

The OIG recently made available its 2014 Work Plan. The Plan identifies OIG focus areas and priority projects for the coming year. This post provides a brief summary of many of the new OIG projects for fiscal year 2014 to...more

Healthcare Provider Investments: Key Points For Regulatory Due Diligence

Private equity investments in healthcare providers have grown exponentially in recent years as investors see the high potential for profitability in the industry. Nonetheless, it is important for investors to keep in mind...more

People ex rel. Farmers Insurance Exchange, et al v. Maurice Hale, M.D., et al

People ex rel. Farmers Insurance Exchange, et al v. Maurice Hale, M.D., et al, case No. BC515676 (California Superior Court, County of Los Angeles; filed July 18, 2013)...more

New York Reports Record-Breaking Medicaid Fraud Recoveries In 2013

In an official press release issued on February 3, New York State Governor Andrew M. Cuomo stated that 2013 was “the largest single year of recoveries of taxpayer dollars in the history of the Office of the Medicaid Inspector...more

Record Numbers for Medicare Fraud Task Force Prosecutions in 2013

On January 27, 2014, the U.S. Department of Justice issued a press release announcing that its Medicare Fraud Task Force had “set record numbers for health care prosecutions in Fiscal Year 2013.” ...more

Hi-Tech Pharmacal Co. to Pay $25 Million in Settlement with Texas AG for Medicaid Fraud

The Texas Attorney General announced on January 7, 2013 that New York pharmaceutical company Hi-Tech Pharmacal Co. will pay the state of Texas and the federal government a combined $25 million to settle the government’s...more

Federal Judge Dismisses All Anti-Kickback Claims in Halifax Hospital Medical Center Case

On January 8, 2014, the U.S. district judge in the Halifax Hospital Medical Center (Hospital) case pending in the Middle District of Florida granted the Hospital's motion to dismiss all of the relator's anti-kickback law...more

Healthcare Fraud Recoveries at All-Time High Since 2009

Fiscal year 2013 marked the fourth consecutive year in which the Department of Justice has recovered at least $2 billion from cases involving charges of healthcare fraud. Make no mistake: these record-setting yields were no...more

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