We are pleased to bring you our 12th annual Healthcare Fraud & Abuse Review. Our Review provides comprehensive coverage of the most significant civil and criminal enforcement issues facing healthcare providers. Each year, we...more
2/27/2024
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Kickbacks ,
Medical Devices ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Qui Tam ,
Settlement ,
Stark Law ,
Telemedicine
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
7/18/2023
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
False Billing ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Hospitals ,
Kickbacks ,
Medical Devices ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians ,
Popular ,
Settlement ,
Stark Law
On February 7, the Department of Justice (DOJ) issued a press release indicating that settlements and judgments under the False Claims Act (FCA) exceeded $2.2 billion in the fiscal year ending September 30, 2022. Of this...more
4/5/2023
/ Corporate Counsel ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Long Term Care Facilities ,
Manufacturers ,
Medical Devices ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Skilled Nursing Facility ,
Suppliers
The third quarter of 2022 brought a number of noteworthy False Claims Act (FCA) settlements, including several over $20 million and one in the high nine figures. This post summarizes key settlements of interest to healthcare...more
The second quarter of 2022 brought a number of noteworthy False Claims Act (FCA) settlements, including several of $20 million or more. This post summarizes key settlements of interest to healthcare providers....more
7/21/2022
/ Anti-Kickback Statute ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Kickbacks ,
Medicaid ,
Medicare ,
OIG ,
Paycheck Protection Program (PPP) ,
Physicians ,
Settlement ,
Whistleblowers
In recent years, the federal government has been particularly aggressive in pursuing civil and criminal enforcement against healthcare entities. Given the highly regulated nature of the field and the ever present risk of...more
The False Claims Act encourages whistleblowers to come forward when they suspect their employer is committing fraud. This post provides a general overview of the False Claims Act’s anti-retaliation provision, which protects...more
5/5/2022
/ Anti-Retaliation Provisions ,
Attorney's Fees ,
Damages ,
Employer Liability Issues ,
Employment Litigation ,
Enforcement Actions ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Fraud ,
Investigations ,
Litigation Fees & Costs ,
Pleading Standards ,
Qui Tam ,
Remedies ,
Retaliation ,
Whistleblower Protection Policies ,
Whistleblowers
The False Claims Act, 31 U.S. C. § 3729, et seq., is the federal government’s most important and most effective tool for fighting fraud. This post provides a high-level overview of the False Claims Act and highlights key...more
On November 4, 2021, the federal Occupational Safety and Health Administration (OSHA) issued its long-awaited emergency standards to implement President Biden’s Vaccine/Testing Mandate for businesses with 100 or more...more
For several years, courts have wrestled with the question of whether subjective clinical decisions regarding the type and amount of treatment patients may need can be false for purposes of establishing False Claims Act (FCA)...more
2/24/2021
/ Appellate Courts ,
Certifications ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Medicare ,
Objective Falsity ,
Physician Medicare Reimbursements ,
Physicians ,
Rule 9(b) ,
SCOTUS ,
Summary Judgment
Ensuring compliance with the False Claims Act has never been more important for healthcare providers. By March 2020, we saw healthcare professionals standing at the forefront of one of the greatest health crises in a...more
2/4/2021
/ Annual Reports ,
Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Criminal Investigations ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Long Term Care Facilities ,
Medical Devices ,
Medicare ,
Medicare Advantage Organizations (MAOs) ,
Nurses ,
Nursing Homes ,
OIG ,
Opioid ,
Pharmaceutical Industry ,
Pharmacist ,
Physicians ,
Qui Tam ,
Settlement Agreements ,
Stark Law ,
Telemedicine
As the market for hemp-based products booms, many investors are grappling with (and consumers unaware of) the grey area within which hemp products are being commercialized across the country. Increasing demand for...more
1/14/2021
/ Cannabis Products ,
Cannabis-Related Businesses (CRBs) ,
Coronavirus/COVID-19 ,
Food and Drug Administration (FDA) ,
Hemp ,
Marijuana Related Businesses ,
Marijuana-Infused Edibles ,
Marketing ,
Product Labels ,
Regulatory Oversight ,
Warning Letters
The Cybersecurity and Infrastructure Security Agency (CISA), the Federal Bureau of Investigation (FBI), and the Department of Health and Human Services (HHS) recently issued a Joint Cybersecurity Advisory in light of...more
12/23/2020
/ Coronavirus/COVID-19 ,
Cyber Crimes ,
Cybersecurity ,
Cybersecurity Information Sharing Act (CISA) ,
Data Breach ,
Department of Health and Human Services (HHS) ,
FBI ,
Health Care Providers ,
Healthcare Facilities ,
Hospitals ,
Ransomware
While neither of the recent cases discussed below establishes new law, they serve as good reminders of principles and requirements that can be important to participants in construction projects in Tennessee. The first case,...more
9/21/2020
/ Appeals ,
Construction Contracts ,
Construction Industry ,
Construction Project ,
Contract Disputes ,
Contract Terms ,
Homeowners ,
Oral Contracts ,
State and Local Government ,
Subcontractors ,
Time is of the Essence ,
Unlicensed Contractors
On July 16, the U.S. District Court for the Middle District of Alabama dismissed a putative class action against Sarrell Regional Dental Center for Public Health relating to a 2019 ransomware incident.
Data Incident and...more
The roller coaster ride of U.S. ex rel. Ruckh v. Genoa Healthcare, LLC continues. In a previous post, we wrote about the staggering $348 judgment entered following a jury verdict against a management company and skilled...more
Absent proper precautions, companies may be forced to produce or otherwise disclose third-party forensic reports generated during a post-breach investigation. Historically, when a data breach has occurred, companies have...more
The COVID-19 pandemic has created significant challenges for many businesses. Some companies, particularly in the travel, hospitality, and leisure industries, have seen revenue drop precipitously. Other companies,...more
The Department of Justice (DOJ) recently released its report detailing the settlements and judgments obtained in 2019 from civil cases involving fraud and abuse claims. As in years past, the substantial majority of these...more
1/28/2020
/ Appeals ,
Department of Justice (DOJ) ,
Dismissals ,
Durable Medical Equipment ,
Enforcement Actions ,
False Claims Act (FCA) ,
Federal Contractors ,
Final Judgment ,
Health Care Providers ,
Kickbacks ,
Medicaid ,
Medicare ,
Pleading Standards ,
Qui Tam ,
Relators ,
Reversal ,
Rule 9(b) ,
Settlement
In two prior posts [Government Files Amended FCA Complaint Against Private Equity Firm and its Portfolio Company and DOJ Intervention in Healthcare Fraud Case Highlights Potential Risks for Private Equity Firms], we wrote...more
11/22/2019
/ Amended Complaints ,
Department of Justice (DOJ) ,
Drug Compounding ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Investors ,
Kickbacks ,
Military Service Members ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians ,
Portfolio Companies ,
Prescription Drugs ,
Private Equity Firms ,
Settlement ,
Telemedicine ,
Veterans
Enforcement activity by the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) showed no signs of slowing throughout 2018 and has already picked up speed in 2019. More recent and significant actions...more
4/25/2019
/ Administrative Law Judge (ALJ) ,
California Consumer Privacy Act (CCPA) ,
Civil Monetary Penalty ,
Compliance ,
Cybersecurity ,
Electronic Medical Records ,
Electronic Protected Health Information (ePHI) ,
Enforcement Actions ,
General Data Protection Regulation (GDPR) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Breach ,
Medical Records ,
OCR ,
Patient Privacy Rights ,
Personally Identifiable Information ,
PHI
This is the second post of a two-part discussion of FCA pleading standards and discusses the pleading requirements for connecting a fraudulent scheme to the submission of false claims. Read our previous post on the...more
Greenway Health LLC, a Tampa-based developer of electronic health records (EHR) software, recently agreed to pay $57.25 million to resolve False Claims Act (FCA) allegations that it overstated the capabilities of and failed...more
The False Claims Act (FCA) continues to be the federal government’s primary civil enforcement tool for imposing liability on healthcare providers who defraud federal healthcare programs. A significant portion of FCA...more
In recent years, healthcare providers have increasingly faced civil and criminal enforcement actions premised on the allegation that services billed to government healthcare programs were not medically necessary. As a result,...more
10/9/2018
/ Appeals ,
Civil Liability ,
Criminal Prosecution ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
False Statements ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Jury Verdicts ,
Medical Necessity ,
Medical Reimbursement ,
Physicians ,
Reversal