News & Analysis as of

Kickbacks

Physicians in the Bulls-eye

by BakerHostetler on

Several recently reported cases highlight the growing risk physicians face if they succumb to competitive pressures, especially offers of remuneration from labs, pharmacies, home health agencies and other providers to whom...more

This Week In Securities Litigation

by Dorsey & Whitney LLP on

Insider trading was a key focus this week. The Commission brought three cases, one involving a doctor tipped by a friend at the company; a second involving a going private transaction were a tip from an insider to his long...more

ArthroCare CEO Reconvicted for Fraud

by Michael Volkov on

The healthcare industry continues to be a frequent target for criminal prosecutions. More importantly, federal prosecutors are ready, willing and able to bring criminal cases against C-Suite actors involved in healthcare...more

Lender-Affiliated Captive Reinsurer Obtains Dismissal Of Mortgage Insurance Lawsuit Brought By Illinois Director Of Insurance

by Carlton Fields on

The suit arose out of an arrangement where lenders would refer borrowers to (now-defunct) Triad Guaranty Insurance Company (Triad) to obtain private mortgage insurance. The lender-affiliated captive insurance company would...more

Maybe the Yacht Was the Tip-Off

by Faegre Baker Daniels on

If you’re a surgical device distributor and you want to reward a surgeon for using your products on Medicare and Medicaid patients, you may want to choose a reward that’s less conspicuous than a yacht. That’s one lesson in...more

You Can’t Ignore RESPA Section 8(c)

by Foley & Lardner LLP on

It’s been over a year since the Consumer Financial Protection Bureau (CFPB) turned the real estate settlement services industry on its head by announcing in its first ever administrative appeal that Section 8(c) of the Real...more

Consultant found guilty of illegal kickbacks by “referring” doctors’ patients to another medical provider in exchange for...

by Dorsey & Whitney LLP on

Under 42 U.S.C. § 1320a-7b(b)(1)(A) it is a felony for a physician to solicit or receive a kickback “in return for referring” a Medicaid or Medicare patient to another medical provider. But as a recent decision by the Eighth...more

FREEP exposes more auto accident attorney kickbacks, No-Fault fraud

by Michigan Auto Law on

Will newest allegations finally get Michigan Attorney Grievance Commission to look into auto accident attorney fraud, kickbacks and illegal solicitation of auto accident victims in Detroit?...more

Second Circuit Ruling Creates Challenge for Securities Class Action Plaintiffs

The Second Circuit recently considered the extraterritorial application of the U.S. securities laws in the private securities class action context, bringing some clarity to an area of the law that is increasingly important...more

Money’s big for Big Pharma — in settlements, lobbying, and product prices

Even as drug makers are settling or scrambling to resolve disputes with regulators over dubious ways they peddle products, Big Pharma is busting records for its spending to lobby lawmakers on skyrocketing prices, easing...more

Medicare Fraud Strike Force Strikes Again – in a Big Way

The Medicare Fraud Strike Force initiated its largest ever healthcare enforcement action, charging 412 defendants in July 2017 with approximately $1.3 billion in fraudulent claims. The Strike Force consists of teams that...more

CFPB Loses Borders Case: the Court Construes RESPA’s Statutory ABA Exemption according to its Plain Language

by Foley & Lardner LLP on

On July 12, 2017, a federal district court in Kentucky issued a summary judgment ruling for the defense in the ongoing Borders & Borders case brought by the Consumer Financial Protection Bureau (CFPB or Bureau). In this...more

Second Circuit Applies Morrison to Rule 23 Predominance Analysis, in In re Petrobras Securities, but Rejects Third Circuit’s...

On July 7, the Second Circuit affirmed in part and vacated in part an order by Judge Rakoff of the S.D.N.Y. certifying two classes in the In re Petrobras Securities litigation, — F.3d –, 2017 WL 2883874 (2d Cir., July 7,...more

CFPB Loses Another RESPA Case

by Ballard Spahr LLP on

A federal district court recently ruled against the CFPB in a long-standing case under the Real Estate Settlement Procedures Act (RESPA) involving a Louisville, Kentucky law firm Borders & Borders, PLC (Borders). In the...more

Amounts Billed Do Not Indicate Fair Market Value In FCA Case

by Reed Smith on

Our day job has been keeping us busy, so busy with depositions, motions, delayed flights, and assorted drama that we have not posted in more than a month. After such a long layoff, we had hoped to return with a vengeance, a...more

Second Circuit Reinforces Narrow Definition of 'Official Act' in Politician's Fraud Case

by Pepper Hamilton LLP on

On July 13, the U.S. Court of Appeals for the Second Circuit vacated the conviction of former New York State Assembly Speaker Sheldon Silver, who was convicted in 2015 on seven counts of honest services fraud, Hobbs Act...more

Silver Conviction Vacated Due To Jury Instructions

Yesterday the Second Circuit (Cabranes, Wesley, Sessions, D.J.) released an opinion vacating the conviction of Sheldon Silver and remanding the case to the district court for further proceedings including a retrial. The...more

Reimbursement Manager Pleads Guilty for Prior Authorization Process Issues

by Bass, Berry & Sims PLC on

On Monday, June 19, 2017, Elizabeth Gurrieri became the second former employee of Insys Therapeutics (Insys) to plead guilty to federal anti-kickback charges related to the drug Subsys, an expensive fentanyl-based painkiller....more

Pennsylvania Federal Court Finds Continuing Violations Doctrine Applicable To RESPA Claims

by Carlton Fields on

A Pennsylvania federal court applied the continuing violations theory to RESPA’s one-year statute of limitations, and allowed Plaintiffs leave to amend their complaint to modify their RESPA claim....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

The 2017 Fla. Legislature Returns To CondoLand

by Bilzin Sumberg on

Once again, after a one-year hiatus, the Florida Legislature has produced several condominium bills. Typically, the Legislature passes a single condominium bill into which other approved bills have been...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

Seven Takeaways from the ABA National Institute On Health Care Fraud

On May 17, 2017 the American Bar Association convened its 27th National Institute on Health Care Fraud. I have attended many of the past annual meetings, and always enjoy the presentations and the opportunity to network with...more

Hospital and its Clinic Agree to $34 Million Settlement to False Claims Act Allegation that Compensation to Oncologists Violated...

Last week, the Department of Justice (DOJ) entered into a $34 million settlement with Mercy Hospital Springfield (“Hospital”) of Springfield, Missouri, and its affiliate Mercy Clinic (“Clinic”). The settlement resolves an...more

Operationalizing Compliance: Part III – Human Resources

by Thomas Fox on

This week I am engaging in a week-long series on how a Chief Compliance Officer (CCO) or compliance practitioner might think about operationalizing a compliance program with other corporate functions and disciplines. I am...more

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