News & Analysis as of

Insurance Fraud Health Insurance

Bass, Berry & Sims PLC

The California Insurance Frauds Prevention Act: Recent Developments Regarding California’s Powerful Commercial Health Insurance...

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We have previously discussed the California Insurance Frauds Prevention Act (IFPA)–a state antifraud statute that, while modeled on the False Claims Act (FCA), is unique in targeting fraud in the commercial health insurance...more

Quarles & Brady LLP

DOJ Enforcement:  Urine Drug Testing

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On April 11, 2024, a jury convicted Northern Kentucky Center for Pain Clinic owner Dr. Timothy Ehn (who was not a medical doctor) and medical director, Dr. William Lawrence Seifert, for their roles in a scheme that defrauded...more

Carlton Fields

Expect Focus - Volume III, September 2023

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Regulators Hit Jackpot: Off-Channel Communications - Several years before announcing the first “off-channel” communications enforcement action, the SEC and FINRA cautioned broker-dealers and investment advisers about...more

Vinson & Elkins LLP

DOJ Intervenes in Another Medicare Advantage FCA Suit

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On September 13, 2021, the Department of Justice (“DOJ”) intervened in a False Claims Act (“FCA”) suit alleging that a health insurer defrauded the government by submitting false patient data to wrongfully inflate payments...more

Vinson & Elkins LLP

Court Chooses Not to Follow Government Sentencing Recommendations for Opioid Executives: Prison Terms Range From 24 to 66 Months

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This past week, a court sentenced the last of seven Insys Therapeutics, Inc. executives for their roles in an opioid racketeering conspiracy. The court sentenced the company’s founder, John Kapoor, to a five-and-a-half-year...more

Saul Ewing LLP

On Demand Insurance is Here But Will it Stay?

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On demand insurance allows insurance policies to be purchased via the internet or smartphone applications. Millennials are more than twice as likely as prior generations to purchase an insurance policy in this manner. Valerie...more

Patrick Malone & Associates P.C. | DC Injury...

Waste, fraud, and abuse? For health insurers, fat profits matter more

What happens when a whistle blower provides detailed information about a burly Texan — with convictions for felony theft and felony injury of a child — and a burgeoning scam to rip off health insurers for $25 million? Pretty...more

Butler Weihmuller Katz Craig LLP

Florida's SIU Tool Belt Is a Bit Lighter Today

Florida has been plagued with insurance fraud for decades.  All insurance coverages are susceptible to fraud, but scams are especially prevalent in the context of automobile accidents.  Staged crashes, patient brokering,...more

Seyfarth Shaw LLP

A Liar and A Cheat? 3 Ways to Pay...

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Seyfarth Synopsis: Insurer gets to pick its remedy when hospital engages in dishonest billing and illegal kickbacks…to the tune of $41 million. Judge Lynn Hughes of the U.S. District Court for the Southern District of...more

Saul Ewing Arnstein & Lehr LLP

OIG Publishes Audit of Outpatient Therapy Services Seeking Return of $3.1 Million in Reimbursements

In June 2013, the Department of Health and Human Services, Office of Investigator General (OIG) published a review of its audit of an outpatient therapy services provider. The OIG concluded that the outpatient therapy...more

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