On 22 February 2024, the US Department of Justice (DOJ) published the statistics for federal civil fraud recoveries in Fiscal Year (FY) 2023. The DOJ announced that the “government and whistleblowers were party to 543...more
6/25/2024
/ Anti-Kickback Statute ,
Compliance ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Internal Investigations ,
Kickbacks ,
Pharmaceutical Industry ,
Settlement ,
White Collar Crimes
On 22 February 2024, the US Department of Justice (DOJ) published its report (Report) announcing civil recoveries under the False Claims Act (FCA) for Fiscal Year (FY) 2023. The recoveries for FY 2023 exceeded US$2.68...more
3/4/2024
/ Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Incentives ,
Paycheck Protection Program (PPP) ,
Physicians ,
Qui Tam ,
Whistleblowers ,
White Collar Crimes
On 16 June 2023, the United States Supreme Court issued a decision in the case of United States ex rel. Polansky v. Executive Health Resources1, holding that the federal government (Government) maintains the authority to...more
The United States Supreme Court recently held that a defendant’s subjective belief is always relevant to the False Claims Act’s scienter element, regardless of what an objectively reasonable person may have believed. This...more
On 7 February 2023, the US Department of Justice (DOJ) publicly reported the statistics for federal civil fraud recoveries in Fiscal Year (FY) 2022. While the DOJ emphasized in its accompanying press release that “the...more
In a significant departure from the general downward trend in False Claims Act (FCA) civil fraud recoveries over the past half-decade —and as predicted last year —recoveries in Fiscal Year (FY) 2021 drastically increased...more
As health care providers are increasingly relying on complex and integrated electronic medical record systems, the health care industry has rapidly become one of the most frequent and often vulnerable targets for...more
8/9/2021
/ Cyber Attacks ,
Cyber Threats ,
Cybersecurity ,
Data Breach ,
Data Privacy ,
Data Protection ,
Data Security ,
Electronic Protected Health Information (ePHI) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
PHI ,
Popular ,
Risk Management
False Claims Act (FCA) civil fraud recoveries in Fiscal Year (FY) 2020 dropped over US$850 million when compared to those in FY 2019. While the more than US$2.2 billion in recoveries in FY 2020 continued a general downward...more
This article analyzes emerging risks to PE firms that invest in the health care sector by examining the current enforcement landscape and significant FCA litigation; identifies key factors that increase FCA risk for PE firms...more
The U.S. Supreme Court’s 2019 decision in Azar v. Allina Health Services effectively curtailed the enforceability of certain Medicare policies established without notice-and-comment rulemaking. As a result, health care fraud...more
On 4 December 2020, the Department of Health and Human Services (HHS) announced the creation of a False Claims Act Working Group (Working Group), with the goal of enhancing HHS’s partnership with the Department of Justice...more
On this week’s episode, John Lawrence, Leah Richardson, and John Rothermich discuss compliance requirements associated with federal funding provided to health care providers through the CARES Act Provider Relief Fund, as well...more
This edition of the Qui Tam Quarterly focuses on the potential False Claims Act (FCA) risk areas faced by health care provider recipients of payments from the Provider Relief Fund (PRF) created by the CARES Act, as well as...more
As many corporate practitioners know from experience, U.S. Department of Justice (DOJ) lawyers and federal prosecutors often factor a company’s inability to pay into corporate civil and criminal resolutions with the...more
On 19 June 2020, in a major reversal of the U.S. Department of the Treasury’s (Treasury) previous position, the U.S. Small Business Administration (SBA) and Treasury announced that they will publicize additional data...more
6/26/2020
/ Borrowers ,
CARES Act ,
Coronavirus/COVID-19 ,
False Claims Act (FCA) ,
Fraud ,
Health Care Providers ,
Investigations ,
Liability ,
Loans ,
Paycheck Protection Program (PPP) ,
Public Information ,
SBA
On this week’s episode, John Lawrence, Myla Reizen and Mark Rush discuss the devastating effects COVID-19 has had on nursing homes and long term care facilities in the United States and potential civil and criminal liability...more
I. INTRODUCTION - As discussed in recent alerts, federal and state authorities have focused their enforcement efforts on combatting fraud related to the COVID-19 pandemic....more
In response to the economic crisis caused by the spread of COVID-19, Congress passed the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) on March 27, 2020, which President Donald J. Trump subsequently signed...more
On March 27, 2020, the United States Congress passed the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, which President Donald J. Trump signed into law on the same day (Public Law No: 116-136). The CARES Act is...more
In recent days, federal and state authorities have prioritized enforcement related activities aimed at combatting fraud schemes arising out of the public uncertainty and desperation caused by the COVID-19 pandemic. ...more
In 2019, the False Claims Act (“FCA”) remained the federal government’s (“Government”) primary method of civil fraud enforcement. While the more than $3 billion in civil fraud recoveries in Fiscal Year (“FY”) 2019 resulted...more
New frontiers are emerging in health care as burgeoning technologies merge with health care’s ever-evolving landscape. While these new frontiers provide seemingly endless possibilities and opportunities for improving the...more
In 2018, the False Claims Act (“FCA”) continued to be one of the federal government’s (“Government”) preferred civil fraud enforcement tools across a variety of industries. The healthcare industry, however, remained the...more
In Part 3 of our series on health care investigations, Mark Rush and John Lawrence discuss the process for external investigations conducted by federal and state governmental agencies, including in the context of qui tam...more
11/27/2018
/ Civil Investigation Demand ,
Dismissals ,
Employee Rights ,
False Claims Act (FCA) ,
Frivolous Lawsuits ,
Government Agencies ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Internal Investigations ,
Obstruction of Justice ,
Qui Tam ,
Search & Seizure ,
Search Warrant ,
Subpoenas ,
Whistleblowers
In Part 2 of our series on health care investigations, Mark Rush and John Lawrence continue the discussion on internal investigations. Specifically, the episode walks through how to conduct an internal investigation,...more
11/27/2018
/ Audits ,
Bias ,
Corrective Actions ,
Data Collection ,
Disclosure Requirements ,
Document Destruction ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Healthcare Workers ,
Internal Investigations ,
Interviews ,
Outside Counsel ,
Policies and Procedures ,
Reporting Requirements ,
Self-Disclosure Requirements ,
Upjohn Warnings