News & Analysis as of

Healthcare False Billing

Kohn, Kohn & Colapinto LLP

Kickbacks and Medically Unnecessary Treatments: Five Major Qui Tam Settlements from May 2024

In May, the U.S. Department of Justice (DOJ) and U.S. Attorneys’ Offices announced several significant False Claims Act (FCA) settlements resolving qui tam whistleblower lawsuits. Under the FCA’s qui tam provisions, a...more

Husch Blackwell LLP

Arizona Physician Pleads Guilty to Healthcare Fraud over Improper “Incident To” Billings

Husch Blackwell LLP on

“Incident to” billing is widely practiced, and its regulations are generally well-known. But one Arizona physician recently found himself pleading guilty in federal court on April 3, 2024, to a criminal healthcare fraud...more

Cozen O'Connor

Whistleblower Watch - A quarterly update on FCA Enforcement and Qui Tam Litigation - Winter 2024

Cozen O'Connor on

Whistleblower Watch is a comprehensive source for all False Claims Act (FCA) news and information. Every quarter, Cozen O’Connor will provide in-house counsel and compliance professionals with a summary of the most notable...more

ArentFox Schiff

Investigations Newsletter: Health Care Network Settles False Claims Act Allegations for $345 Million

ArentFox Schiff on

Health Care Network Settles False Claims Act Allegations for $345 Million - Community Health Network Inc. (CHN) has agreed to pay $345,000,000 to settle allegations that it violated the False Claims Act (FCA) for knowingly...more

Epstein Becker & Green

Supreme Court Holds the FCA Scienter Standard Is Subjective, but How Will This Impact Future FCA Litigation?

Epstein Becker & Green on

On June 1, 2023, the U.S. Supreme Court unanimously settled a long-standing dispute over a subjective versus objective standard for scienter under the False Claims Act (FCA), holding that a defendant’s own subjective belief...more

Health Care Compliance Association (HCCA)

News Briefs: August 14, 2023

Report on Medicare Compliance Volume 32, no 29 (August 2023) In a new Medicare transmittal (12,202), CMS introduced a new place of service (POS) code (27) for “Outreach Site/Street.” POS 27 is defined as “a non-permanent...more

Bass, Berry & Sims PLC

False Claims Act Settlements to Know from Q2 2023

Bass, Berry & Sims PLC on

There have been several noteworthy False Claims Act (FCA) settlements in the second quarter of 2023.  Four of these settlements have come in over $20 million. This post summarizes key settlements of interest....more

Health Care Compliance Association (HCCA)

News Briefs: July 2023

Report on Medicare Compliance Volume 32, no 25 (July 2023) Hospices in four states will face heightened oversight. “CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional...more

The Volkov Law Group

The Unique Elements of Healthcare Compliance Programs (Part II of II)

The Volkov Law Group on

Corporate compliance programs in the healthcare industry include many of the same elements that we are all familiar with – risk assessments, code of ethics, written policies and procedures, comprehensive training...more

Cozen O'Connor

The State AG Report – 4.28.2023

Cozen O'Connor on

Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •FTC Targets Optometrists, Ophthalmologists Suspected of...more

Health Care Compliance Association (HCCA)

Enforcement actions relating to a lack of medical necessity

In a climate of shrinking margins, diminishing reimbursement, and frequent denials, healthcare organizations may make efforts to increase the volume of services they provide, especially those that are more profitable. Of...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 31, Number 43. News Briefs: December 2022

HealthOne Critical Care Transport Service Inc., doing business as MedicOne Medical Response of Marion, Illinois, has agreed to pay $302,124 to settle allegations it improperly billed Medicare for scheduled, non-emergency...more

Epstein Becker & Green

Telemental Health Laws: Overview - 2022

Epstein Becker & Green on

Since 2016, Epstein Becker Green (EBG) has researched, compiled, and analyzed state-specific content relating to the regulatory requirements for professional mental/behavioral health practitioners and stakeholders seeking to...more

Akerman LLP - Health Law Rx

Recent FCA Settlements Warn Providers of Improper Billing Practices

Two recent multi-million dollar False Claims Act (“FCA”) settlements demonstrate the vigor with which the Department of Justice (“DOJ”) is investigating and prosecuting allegedly fraudulent health care billing practices....more

Robinson+Cole Health Law Diagnosis

Supreme Court Denies Certiorari in Three FCA “Particularity” Cases.

On October 17, 2022, the Supreme Court denied certiorari in three cases asking the court to resolve a circuit split regarding the application of the particularity pleading requirement for allegations of fraud in False Claims...more

The Volkov Law Group

DOJ Announces Two Significant Indictments Charging Individuals with Healthcare Fraud

The Volkov Law Group on

The Justice Department is continuing to use criminal enforcement as an important tool in the fight against healthcare fraud.  While the False Claims Act continues its important place in the fight against healthcare fraud, DOJ...more

Rivkin Radler LLP

Private Insurers Must Watch Out for Medical Equipment Fraud

Rivkin Radler LLP on

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

Rivkin Radler LLP

NY Medical Practice Settles False Claims Act Allegations Related to “Incident-To” Billing

Rivkin Radler LLP on

On August 3, North Country Neurology, P.C., a physician-owned medical practice located in Watertown, NY (the “Practice”), reached a settlement with the U.S. Attorney’s Office for the Northern District of New York to pay...more

Robinson+Cole Health Law Diagnosis

Suspect Characteristics Identified under a Telehealth Special Fraud Alert

HHS-OIG issued a new Special Fraud Alert on relationships with “purported telemedicine companies” on July 20, 2022. The Special Fraud Alert comes on the heels of a nationally coordinated takedown charging dozens of...more

Fox Rothschild LLP

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

Fox Rothschild LLP on

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

Farrell Fritz, P.C.

Supreme Court To Decide Standard For Government Dismissal Of False Claims Act Cases

Farrell Fritz, P.C. on

The Supreme Court granted certiorari in a case that will decide two important questions under the False Claims Act (FCA).  In United States ex rel. Polansky v. Executive Health Resources, Inc., the Relator asks the Court to...more

Fox Rothschild LLP

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

Fox Rothschild LLP on

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

Robinson+Cole Health Law Diagnosis

DOJ Focused on Toxicology Testing – EKRA and Anti-Kickback Statute Violations Abound

On November 4, 2021, the Department of Justice (DOJ) announced the conviction of several South Florida addiction treatment facility operators following a seven-week trial. ...more

McDermott Will & Emery

The Growing Role of Data Analytics in Healthcare Enforcement

McDermott Will & Emery on

The US Department of Justice (DOJ) and US Department of Health and Human Services, Office of Inspector General (HHS-OIG) are increasingly relying on sophisticated data analytics tools to identify and investigate fraud...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

43 Results
 / 
View per page
Page: of 2

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide