On April 23, the US Department of Labor (DOL) released a final rule significantly expanding the definition of who qualifies as a fiduciary under the Employee Retirement Income Security Act (ERISA) (the Retirement Security...more
5/15/2024
/ Biden Administration ,
Department of Labor (DOL) ,
Employee Retirement Income Security Act (ERISA) ,
Exemptions ,
Fiduciary ,
Final Rules ,
Internal Revenue Code (IRC) ,
Investment ,
Pensions ,
Prohibited Transactions ,
Retirement Plan ,
Securities and Exchange Commission (SEC)
Big Baby’s Big Foul: Former NBA Star Glen 'Big Baby' Davis Sentenced to 40 Months for Healthcare Fraud Scheme -
On May 9, former Boston Celtics forward Glen “Big Baby” Davis was sentenced to 40 months in prison following...more
5/13/2024
/ Anti-Kickback Statute ,
CIMA ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Healthcare ,
Healthcare Fraud ,
Hospice ,
Kickbacks ,
Medicare ,
NBA ,
Wire Fraud
In a win for plaintiffs, the US Court of Appeals for the Ninth Circuit recently reversed a district court’s dismissal of key claims in the case of Ryan S. v. UnitedHealth Group, Inc. The case provides useful guidance for...more
DOJ Secures Plea in $50 Million Medicare Fraud and Kickback Scheme -
On April 26, the US Department of Justice (DOJ) announced that Manishkumar Patel pleaded guilty to charges related to a $50 million health care fraud and...more
5/6/2024
/ Anti-Kickback Statute ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Food and Drug Administration (FDA) ,
Guilty Pleas ,
Healthcare Fraud ,
HRSA ,
Kickbacks ,
Medicare Fraud ,
Money Laundering ,
Paycheck Protection Program (PPP) ,
Retaliation ,
Telemarketing ,
Whistleblowers ,
Wire Fraud
Former Comptroller of Ecuador Convicted in International Bribery and Money Laundering Scheme -
On April 24, a Miami jury convicted Carlos Ramon Polit Faggioni, the former Comptroller General of Ecuador, for his role in an...more
4/30/2024
/ Bribery ,
Conspiracies ,
Controlled Substances ,
Dark Web ,
Department of Justice (DOJ) ,
Ecuador ,
Misrepresentation ,
Money Laundering ,
Securities and Exchange Commission (SEC) ,
Securities Fraud ,
Sentencing ,
Wire Fraud
Georgia Laboratory Owner Pleads Guilty to Felony Anti-Kickback Statute Violations -
On February 28, the US Department of Justice (DOJ) announced the guilty plea of Andrew Maloney, who, along with his clinical laboratory...more
3/11/2024
/ Anti-Kickback Statute ,
Criminal Investigations ,
Department of Justice (DOJ) ,
Drug Testing ,
False Claims Act (FCA) ,
Federal Food Drug and Cosmetic Act (FFDCA) ,
Fines ,
Fraud ,
Guilty Pleas ,
Healthcare Fraud ,
IRS ,
Medicaid ,
Medicare Fraud ,
Opioid ,
Sentencing ,
Settlement ,
Tax Evasion ,
TRICARE
On January 30, a federal jury found six people guilty of federal civil rights offenses arising from their participation in a blockade of a reproductive health care clinic in Mount Juliet, Tennessee. The jury’s verdict is...more
In a recent opinion, E.W. v. Health Net Life Insurance Co., the US Court of Appeals for the Tenth Circuit clarified the elements that plaintiffs must plead to state claims under the Mental Health Parity and Addiction Equity...more
On December 18, 2023, the US Departments of Treasury, Labor, and Health and Human Services (the Departments) issued a rule finalizing the 2024 non-refundable administrative fee parties must pay to access the arbitration...more
With the surge of interest in artificial intelligence (AI), it should be no surprise that health insurers have come under scrutiny concerning their use of AI predictive tools to deny medical insurance claims.
The question...more
12/22/2023
/ Algorithms ,
Artificial Intelligence ,
Automated Decision Systems (ADS) ,
Beneficiaries ,
Breach of Duty ,
CIGNA ,
Class Action ,
Health Care Providers ,
Health Insurance ,
Insurance Claims ,
Patients ,
United Healthcare Insurance Co.
Hospital Executive and Three Physicians to Pay More Than $880,000 to Resolve Kickback Allegations -
On Monday, December 4, 2023, a Lexington, Texas, hospital executive and three health care providers agreed to pay more...more
12/11/2023
/ Clinical Laboratory Testing ,
Conspiracies ,
Controlled Substances ,
Criminal Convictions ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Healthcare Facilities ,
Kickbacks ,
Medicaid ,
Medicare ,
Medicare Fraud ,
Settlement ,
TRICARE ,
Wire Fraud
*This is the 12th article in a series analyzing the No Surprises Act and its implementation. To view the entire series, click here. A link to the proposed rule is here. As background, Congress passed the Act to prevent...more
Binance to Pay Historic $4 Billion Fine -
Binance Holdings Limited, the operator of the world’s largest cryptocurrency exchange, agreed to pay $4.3 billion to resolve allegations that it violated the Bank Secrecy Act (BSA)...more
12/4/2023
/ Anti-Kickback Statute ,
Anti-Money Laundering ,
Bank Secrecy Act ,
Compliance ,
Cryptocurrency ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
FinCEN ,
Fines ,
Fraud ,
International Emergency Economic Powers Act (IEEPA) ,
IRS ,
Kickbacks ,
Know Your Customers ,
Medicare ,
Money Laundering ,
Money Transmitter ,
Offshore Funds ,
Tax Fraud ,
Tax Preparers ,
Willful Misconduct
On September 21, 2023, the US Departments of Treasury (DOT), Labor (DOL), and Health and Human Services (HHS) (the Departments) issued new rulemaking governing the administrative fee required to access the arbitration process...more
10/4/2023
/ Arbitration ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Fees ,
Final Rules ,
No Surprises Act (NSA) ,
Proposed Regulation ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury
Engineering Company Agrees to Pay $4.4 Million to Settle FCA -
On Friday, September 15, 2023, the US Department of Justice (DOJ) announced a settlement agreement with Navmar Applied Sciences Corporation, a...more
9/25/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Federal Acquisition Regulations (FAR) ,
Federal Health Care Programs (FHCP) ,
Healthcare Fraud ,
Identity Theft ,
Kickbacks ,
Settlement ,
U.S. Navy ,
Whistleblowers
Co-Founder of Fraudulent Cryptocurrency Sentenced to 20 Years in Prison -
Karl Sebastian Greenwood, a citizen of Sweden and the United Kingdom and co-founder of the cryptocurrency OneCoin, was sentenced to 20 years in...more
9/18/2023
/ Blockchain ,
Coronavirus/COVID-19 ,
Cryptocurrency ,
Department of Justice (DOJ) ,
Embezzlement ,
Fraud ,
Identity Theft ,
Misrepresentation ,
MLM Industry ,
Nonprofits ,
Sentencing
On August 24, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rulemaking under the federal No Surprises Act (the Act). This marked...more
Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage...more
On August 3, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rules governing fee collection and claim batching under the federal...more
8/22/2023
/ Administrative Procedure Act ,
Arbitration ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Fees ,
Health Care Providers ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury
On July 25, 2023, the US Departments of Labor (DOL), Treasury (DOT), and Health and Human Services (HHS) (the Departments) released a much-anticipated interim final rule to ensure that group health plans comply with the...more
8/16/2023
/ Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Department of Transportation (DOT) ,
Interim Final Rules (IFR) ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Proposed Rules ,
Rulemaking Process ,
Substance Abuse
New FCA Filings Point to Future Path Forward For Companies -
The US Supreme Court recently ruled in United States ex rel. Proctor v. Safeway Inc. and United States ex rel. Schutte, et al. v. SuperValu Inc. et al. that...more
$140 Million Healthcare Fraud Case to Be Retried -
On June 27, a Houston federal district court judge indicated that a $140 million healthcare fraud case, which ended in mistrial in December 2022 due to allegations of...more
In the year following the implementation of the arbitration process established under the federal No Surprises Act (NSA), more than 330,000 disputes have been submitted for resolution. This figure far outpaces the predictions...more
Recent Interview With FCA Plaintiff Bar Attorneys Offers Key Insight into Trends in Anti-Kickback Litigation -
During a recent interview commemorating the 50th anniversary of the enactment of the Anti-Kickback Statute, two...more
Pennsylvania Medical Supply Company Agrees to $5 Million Settlement -
A Pennsylvania medical supply company, AdaptHealth LLC, formerly known as QMES LLC, agreed to a $5.3 million settlement to resolve allegations that it...more