Kickbacks

News & Analysis as of

Health Care Fraud Prosecutions: Strong Seas and High Winds Ahead for Individuals and Corporations

During the past nine months, the U.S. Department of Justice (DOJ) has made several significant policy pronouncements that impact health care organizations and individual providers. These directives and initiatives reflect...more

OIG Delivers Home Care a One – Two Punch: Release of Report and Alert on Home Health Fraud Highlights Increased OIG Scrutiny of...

On June 22, 2016, the Office of Inspector General (“OIG”) issued two communications that underscore its continued focus on fraud in home health care, along with the role of physicians as “gate keepers” in authorizing...more

Jury Acquits Former Pharma Exec in One of the First Post-Yates Memo Health Care Fraud Prosecutions

Like many before it, this year has been one to watch in government health care fraud enforcement efforts. In September 2015, the Department of Justice (DOJ) released the “Yates Memo,” which reaffirmed the government’s...more

Compliance Reminder — DOJ Announces Largest Healthcare Fraud Takedown

On Wednesday, June 22, 2016, the DOJ announced the largest nationwide heath care fraud takedown in history, which resulted in criminal and civil charges against 301 individuals for alleged participation in health care fraud...more

DOJ Suffers Criminal Trial Setbacks: Warner Chillcott President Acquitted

Last week was a tough week for the Justice Department’s criminal prosecutors. Before everyone gets out their Yates Memorandum trending claims, it is important to recognize that DOJ’s loss in several high profile cases does...more

Prosecutors win $67 million settlement with pharma firms accused of deceit

Federal prosecutors have wrung $67 million in a settlement with two pharmaceutical companies accused of deceiving doctors to prescribe a drug that the firms knew would be ineffective in treating lung cancer patients....more

Corporate Investigations and White Collar Defense - June 2016

Eye on the Supreme Court—Corruption and Fraud Edition - Why it matters: This session, the Supreme Court has undertaken the review of numerous cases that raise thorny issues arising in the white collar context. In our...more

Court Orders Cigna to Pay Out-of-Network Surgical Claims

On June 1, 2016, the United States District Court for the Southern District of Texas ordered Cigna to pay nearly $13.7 million to Humble Surgical Hospital, LLC (“Humble”). Of the nearly $13.7 million, almost $11.4 million...more

Does the Medical-School-to-Prison Pipeline Widen in Middle Age?

The trend of holding physicians personally responsible for healthcare crimes has continued unabated over the past year. As noted in a previous article, physicians are particularly attractive targets for federal prosecutors...more

In a Case of First Impression, Delaware Chancery Court Holds It’s “Out with the Old (Board) and In With the New” When Considering...

On May 31, 2016, the Delaware Chancery Court rejected shareholders’ allegations of corporate wrongdoing in a derivative suit against a national healthcare company, Bioscrip, holding that Plaintiff failed to adequately allege...more

Global Construction and Corruption

With increasing focus on infrastructure projects and greater public demand for improvements, governments are preparing to ramp up construction projects. Part of the budgeting process has to acknowledge the cost of corruption....more

Cutting Through the Constitutionality Haze in the Battle Between PHH Corporation and the Consumer Financial Protection Bureau

So much has been written in recent weeks about the battle between PHH Corporation and the Consumer Financial Protection Bureau in the U.S. Court of Appeals for the D.C. Circuit. The panel heard oral argument on April 12,...more

Top Ten International Anti-Corruption Developments for April 2016

In order to provide an overview for busy in-house counsel and compliance professionals, we summarize below some of the most important international anti-corruption developments from the past month, with links to primary...more

This Week In Securities Litigation

The Commission prevailed at trial this week, securing a favorable verdict after a two week jury trial. The action centered on false statements made by an executive regarding regulatory approvals for the only drug of the...more

Compliance Program Lessons from a Recidivist

Recidivist behavior is something that the US government is forced to face in Foreign Corrupt Practices Act (FCPA) enforcement from time-to-time. When a company agrees to a Deferred Prosecution Agreement (DPA) or...more

A Day of Reckoning for the CFPB?

Virtually ever since its inception on July 21, 2011, the Consumer Financial Protection Bureau (CFPB) has inspired wariness and skepticism in the financial institutions and financial services providers, subject to this new...more

Is the CFPB Constitutional?

Is the Consumer Financial Protection Bureau (CFPB) constitutional? A panel of the D.C. Circuit Court of Appeals is currently considering the issue after hearing oral argument in PHH Corporation v. CFPB....more

The Supreme Court - May 2016

The Supreme Court of the United States issued one decision on May 2, 2016: Ocasio v. United States, No. 14-361: Petitioner Samuel Ocasio, a former police officer, was tried and convicted under the Hobbs Act for...more

Supreme Court Decides Ocasio v. United States

A defendant may be convicted of conspiring to violate the Hobbs Act, 18 U. S. C. §1951, based on proof that the defendant reached an agreement with the owner of the property in question to obtain that property under color of...more

Tougher Oversight Needed on Harms of Medical Devices

Problems with medical devices contribute to 3,000 Americans’ deaths annually, research shows, and fixing any one of the problem devices can cost hundreds of millions. So why aren’t government officials doing more and better...more

Insurer Actions Cut the Heart Out of Out-of-Network Providers

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more

PHH v. CFPB: "What is a Kickback?"

On April 12, 2016, a panel of the U.S. Court of Appeals for the D.C. Circuit heard oral argument in PHH Corporation’s (PHH) milestone legal battle with the Consumer Financial Protection Bureau (Bureau). During the argument,...more

Aetna vs. BASM: Pigs Get Fat and Hogs Get Slaughtered

On April 13, 2016, a jury in Santa Clara, California awarded Aetna, Inc. $37.4 million from Bay Area Surgical Management, LLC (“BASM”), six of its affiliated surgery centers and its three principals. Aetna had accused the...more

PHH Mortgage Attacks the CFPB: Will the Bureau Become a Commission?

On April 12, the U.S. Court of Appeals for the D.C. Circuit heard arguments in PHH Mortgage’s appeal of a $109,000,000 disgorgement order by the CFPB. The CFPB found PHH had illegally referred consumers to mortgage insurers...more

Oral Arguments in PHH Case Signal Trouble for CFPB

The D.C. Circuit held oral arguments on April 12, 2016 in the case PHH Corp v. Consumer Financial Protection Bureau (CFPB), a case challenging the CFPB’s constitutionality as well as its interpretations of the Real Estate...more

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