Massachusetts District Court Judge Applies Heightened Causation Standard in FCA Case -
On January 6, a District Court of Massachusetts judge granted summary judgment for defendants on allegations of violating the...more
1/27/2025
/ Anti-Kickback Statute ,
Causation ,
Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Medicare Advantage ,
Opioid ,
Paycheck Protection Program (PPP) ,
Qui Tam ,
SCOTUS ,
Settlement ,
Skilled Nursing Facility ,
Whistleblowers
DOJ Reports Nearly $3 Billion in FCA Settlements, Judgments for FY 2024 -
On January 15, the US Department of Justice (DOJ) reported that settlements and judgments under the False Claims Act (FCA) totaled more than $2.9...more
1/20/2025
/ Criminal Prosecution ,
Cryptocurrency ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Investment Fraud ,
Medicare ,
Medicare Advantage ,
Pharmaceutical Industry ,
Pharmacies ,
Settlement ,
Whistleblowers ,
Wire Fraud
Florida Telemarketer Sentenced to 15 Years in Prison for $67 Million Medicare Fraud Scheme -
On December 6, Jose Goyos was sentenced to 15 years in prison for his role in managing a deceptive telemarketing scheme to...more
12/16/2024
/ Beneficiaries ,
Department of Justice (DOJ) ,
Florida ,
Food and Drug Administration (FDA) ,
Insider Trading ,
Investors ,
Medicare Fraud ,
Money Laundering ,
Securities Fraud ,
Sentencing ,
Telemarketing ,
Wire Fraud
Seventh Circuit Considers When Legal Marketing Transforms Into Illegal Kickbacks -
On December 4, the US Court of Appeals for the Seventh Circuit heard oral arguments regarding whether the January 2023 jury conviction of...more
12/9/2024
/ Anti-Kickback Statute ,
Appeals ,
Bribery ,
Department of Justice (DOJ) ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Marketing ,
Medicare Fraud ,
Sentencing ,
TRICARE
Expanding on the peer review protections established in Bonni v. St. Joseph Health System, the California Court of Appeal in Dignity Health v. Mounts held that a wide array of medical staff communications regarding peer...more
In a significant move toward regulating artificial intelligence (AI) in health care, Assembly Bill (AB) 3030 will require health facilities, clinics, and physician practices in California to provide disclaimers to patients...more
DOJ Launches Corporate Whistleblower Awards Pilot Program -
On August 1, the US Department of Justice (DOJ) announced the details of its new Corporate Whistleblower Awards Pilot Program. According to the DOJ, the...more
8/12/2024
/ Bribery ,
Controlled Substances Act ,
DEA ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
False Claims Act (FCA) ,
FinCEN ,
Foreign Corrupt Practices Act (FCPA) ,
Health Insurance ,
Healthcare Fraud ,
Internal Reporting ,
Kickbacks ,
Opioid ,
Pilot Programs ,
Securities and Exchange Commission (SEC) ,
Whistleblower Awards ,
Whistleblowers ,
Wire Fraud
Welcome to the Summer 2024 issue of “FCA Enforcement & Compliance Digest,” our quarterly newsletter in which we compile essential updates on False Claims Act (FCA) enforcement trends, litigation, agency guidance, and...more
7/31/2024
/ Anti-Kickback Statute ,
Beneficiaries ,
Bring Your Own Device (BYOD) ,
But For Causation ,
Compliance ,
Department of Justice (DOJ) ,
Enforcement ,
Fair Market Value ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Oral Argument ,
Physician Compensation Arrangements ,
Policies and Procedures ,
Portability ,
Settlement ,
Stark Law ,
TRICARE ,
Valuation
Chicago Laboratory Owner Charged with Defrauding Medicare in $60 Million COVID-19 Test Kit Scheme -
The Chicago-based owner of two laboratories, Zoom Labs Inc. and Western Labs Co., has been charged with health care fraud...more
6/17/2024
/ Chronic Care Managment (CCM) ,
Coronavirus/COVID-19 ,
Damages ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
HRSA ,
Kickbacks ,
Medicaid ,
Medicare ,
Medicare Fraud ,
Penalties ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
TRICARE ,
Uninsured Patients
District Court Declines to Stay Case Pending Resolution of FCA Causation Standard Issue Before Court of Appeals -
Earlier this week, a Massachusetts federal judge denied a motion to stay proceedings filed by Medtronic,...more
6/10/2024
/ Anti-Kickback Statute ,
Appeals ,
Causation ,
Criminal Convictions ,
Cryptocurrency ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Healthcare Fraud ,
Mail Fraud ,
Ponzi Scheme
On February 14, the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued its annual reports to Congress detailing its actions to enforce the privacy, security, and breach notification...more
5/9/2024
/ Breach Notification Rule ,
Covered Entities ,
Cyber Attacks ,
Cybersecurity ,
Data Security ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Hackers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Information Technology ,
OCR ,
PHI ,
Privacy Laws
The recently passed Consolidated Appropriations Act (CAA) of 2023 includes a new Stark Law exception and Anti-Kickback Statute (AKS) safe harbor, allowing hospitals and other health care entities to offer their physicians...more
6/13/2023
/ Anti-Kickback Statute ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Healthcare ,
Hospitals ,
Medicare ,
Mental Health ,
Physicians ,
Safe Harbors ,
Stark Law ,
Wellness Programs
According to guidance published by the Centers for Medicare and Medicaid Services (CMS) on July 11, 2022, EMTALA, the Emergency Medical Treatment and Labor Act of 1986, requires hospitals to provide abortion services when...more
7/28/2022
/ Abortion ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Dobbs v. Jackson Women’s Health Organization ,
EMTALA ,
First Amendment ,
New Guidance ,
Planned Parenthood ,
Planned Parenthood of Southeastern Pennsylvania v Casey ,
Pregnancy ,
Religious Institutions ,
Roe v Wade ,
SCOTUS
In Khoiny v. Dignity Health, the California Court of Appeal held that hospital residency programs are primarily employment programs and medical residents are primarily employees. Therefore, courts should not give special...more
The HHS Office for Civil Rights is requesting comments about HIPAA covered entities’ and business associates’ implementation of “recognized security practices” and payments to “harmed individuals” from funds the agency...more
In Scheer v. Regents of the University of California, the Second District Court of Appeal held that the McDonnell-Douglas burden-shifting framework applies to claims asserted pursuant to Health & Safety Code Section 1278.5....more
Some commentators have misinterpreted the Bichai decision to mean that a medical staff and its affiliated hospital are entirely independent of each other. In reality, the two entities are practically and legally...more
On February 22, 2022, the California Department of Public Health (CDPH) announced that vaccinated health care workers with documented recent infection will be allowed to defer booster shot by up to 90 days from...more