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
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
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
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
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
After years of investigation and litigation, and on the eve of a highly anticipated trial, the government abandoned its FCA case against ManorCare, the nation’s second-largest operator of skilled nursing homes and assisted...more
11/27/2017
/ Assisted Living Facilities (ALFs) ,
Damages ,
Department of Justice (DOJ) ,
Discovery ,
Dismissal With Prejudice ,
Expert Witness ,
False Claims Act (FCA) ,
Fines ,
Interlocutory Appeals ,
Medical Necessity ,
Medical Records ,
Medicare ,
Motion to Dismiss ,
Nursing Homes ,
Reasonable Care ,
Skilled Nursing Facility
A recent jury verdict in an FCA lawsuit pending in the United States District Court for the Middle District of Florida resulted in a not-so-subtle reminder of just how high the stakes can be in such litigation....more
3/15/2017
/ Civil Monetary Penalty ,
Discovery Disputes ,
False Billing ,
False Claims Act (FCA) ,
Healthcare Fraud ,
Jury Verdicts ,
Medicaid ,
Medicare ,
Skilled Nursing Facility ,
Statistical Sampling ,
Treble Damages
A number of recent FCA decisions have grappled with the question of objective falsity, particularly in the context of FCA claims where the alleged falsity is premised on a lack of medical necessity in connection with the...more
In one of the few cases to apply the Supreme Court’s recent decision in Universal Health Services v. Escobar, the Seventh Circuit recently revisited and affirmed its prior rejection of an implied certification claim under the...more
11/30/2016
/ Colleges ,
Conditions of Payment ,
Corporate Counsel ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Higher Education Act ,
Materiality ,
Reaffirmation ,
Relators ,
Subsidies ,
Title IV ,
United States ex rel Nelson v Sanford-Brown ,
Universal Health Services Inc v United States ex rel Escobar