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
On February 22, the Department of Justice (DOJ) released its annual report of civil fraud recoveries for FY2023, along with a press release highlighting DOJ’s civil enforcement efforts.
Our top ten observations from...more
2/26/2024
/ Annual Reports ,
Anti-Kickback Statute ,
Controlled Substances Act ,
Cybersecurity ,
Department of Justice (DOJ) ,
Enforcement Actions ,
Enforcement Statistics ,
False Claims Act (FCA) ,
Fraud ,
Fraud and Abuse ,
Healthcare ,
Opioid ,
Qui Tam ,
Relators
Please join us for the 9th Annual Nashville Healthcare Fraud Conference hosted by Bass, Berry & Sims and the Tennessee Hospital Association. Eligible for more than seven hours of CLE credit (including ethics), this...more
11/27/2023
/ Anti-Kickback Statute ,
C-Suite Executives ,
Chief Compliance Officers ,
Chief Privacy Officer ,
Continuing Legal Education ,
Criminal Liability ,
Department of Justice (DOJ) ,
Enforcement ,
Ethics ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Hospitals ,
Laboratories ,
Long-Term Care ,
MCOs ,
Mental Health ,
Physicians ,
Self-Disclosure Requirements ,
Substance Abuse ,
Webinars
Please join us for the 9th Annual Nashville Healthcare Fraud Conference hosted by Bass, Berry & Sims and the Tennessee Hospital Association. Eligible for more than seven hours of CLE credit (including ethics), this...more
11/27/2023
/ Anti-Kickback Statute ,
C-Suite Executives ,
Chief Compliance Officers ,
Chief Privacy Officer ,
Continuing Legal Education ,
Criminal Liability ,
Department of Justice (DOJ) ,
Enforcement ,
Ethics ,
Events ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Hospitals ,
Laboratories ,
Long-Term Care ,
MCOs ,
Mental Health ,
Physicians ,
Self-Disclosure Requirements ,
Substance Abuse
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
One of the first indicators that may tip off a healthcare provider or government contractor that their organization may be the subject of a False Claims Act (FCA) investigation is contact with a government investigator. That...more
1/19/2021
/ Civil Investigation Demand ,
Employees ,
False Claims Act (FCA) ,
Federal Contractors ,
Government Investigations ,
Health Care Providers ,
Interviews ,
Law Enforcement ,
Policies and Procedures ,
Search Warrant ,
Subpoenas
As 2020 draws to a close, we take a look back at a number of the most significant False Claims Act (FCA) cases of the prior 12 months. Although no blockbuster cases emerged, such as the Supreme Court’s 2016 decision in...more
On May 6, the U.S. District Court for the District of South Carolina entered final judgment dismissing with prejudice a relator’s qui tam False Claims Act (FCA) suit against the defendant wholesale pharmacy. The relator, a...more
A LOOK BACK.... A LOOK AHEAD -
Perhaps the single most appropriate word to describe the current state of the civil and criminal healthcare fraud enforcement environment is uncertainty. From changes in personnel and policy...more
1/31/2019
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Medical Devices ,
Opioid ,
Pharmaceutical Industry ,
Physician Medicare Reimbursements ,
Prescription Drugs ,
Qui Tam ,
Stark Law
Perhaps the single most appropriate word to describe the current state of the civil and criminal healthcare fraud enforcement environment is uncertainty. From changes in personnel and policy at the highest levels of...more
1/16/2019
/ Appointments Clause ,
Article II ,
Article III ,
Constitutional Challenges ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Dismissals ,
Drug Distribution ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Materiality ,
Opioid ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Qui Tam ,
Relators ,
Standing ,
Universal Health Services Inc v United States ex rel Escobar ,
Whistleblowers
On November 16, 2018, the U.S. Supreme Court granted certiorari in Cochise Consultancy, Inc. v. U.S. ex rel. Hunt, agreeing to decide how the FCA’s statute of limitations applies in qui tam actions brought by a private...more
A LOOK BACK... A LOOK AHEAD -
While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more
3/13/2018
/ Affordable Care Act ,
Anti-Kickback Statute ,
Attorney's Fees ,
Attorney-Client Privilege ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Damages ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Discovery ,
Enforcement Actions ,
False Claims Act (FCA) ,
First-to-File ,
Food and Drug Administration (FDA) ,
Fraud and Abuse ,
Health Care Providers ,
Health Insurance ,
Healthcare Fraud ,
Home Health Care ,
Hospice ,
Hospitals ,
Individual Accountability ,
Laboratories ,
Long-Term Care ,
Managed Care Contracts ,
Manufacturers ,
Medicaid ,
Medical Devices ,
Medical Necessity ,
Medical Records ,
Medicare ,
Nursing Homes ,
OIG ,
Pharmaceutical Industry ,
Physicians ,
Pleading Standards ,
Protected Activity ,
Public Disclosure ,
Qui Tam ,
Relators ,
Retaliation ,
Reverse False Claims ,
Settlement Agreements ,
SNF ,
Specialty Healthcare ,
Stark Law ,
Universal Health Services Inc v United States ex rel Escobar
The FCA provides protections for whistleblowers in connection with their whistleblowing activities. To establish that an employer retaliated against an employee in violation of 31 U.S.C. § 3730(h), an employee must...more
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more
7/7/2017
/ Calculation of Damages ,
Civil Monetary Penalty ,
Corporate Counsel ,
Damages ,
Davis-Bacon Act ,
False Claims Act (FCA) ,
Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 ,
Federal Contractors ,
Health Care Providers ,
State Contractors ,
Treble Damages
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more
6/24/2017
/ Amended Complaints ,
Drug Pricing ,
False Claims Act (FCA) ,
Federal Contractors ,
FOIA ,
Fraud ,
Health Care Providers ,
Level of Generality Test ,
Public Disclosure ,
Qui Tam ,
Relators
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we will...more
6/13/2017
/ Actual or Constructive Knowledge ,
Ambiguous ,
Appeals ,
Dismissals ,
Enforcement Actions ,
False Claims Act (FCA) ,
Federal Contractors ,
Health Care Providers ,
Objective Unreasonableness Standard ,
Relators ,
Remand ,
Scienter ,
Summary Judgment
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we will...more
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we are...more
In the recent past, the government has racked up a number of FCA settlements based on alleged violations of the Anti-Kickback Statute (AKS). This focus undoubtedly will remain a high enforcement priority....more
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we will...more
The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we are...more
The government’s FCA enforcement efforts have continued to focus on key areas concerning the pharmaceutical and medical device industries. In fact, drug and device manufacturers accounted for nearly half of the enforcement...more
5/16/2017
/ Anti-Kickback Statute ,
Discount Pricing ,
False Claims Act (FCA) ,
Fraud ,
GlaxoSmithKline ,
Health Insurance ,
Medical Devices ,
Off-Label Promotion ,
Pfizer ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians ,
Prescription Drugs ,
RICO