Federal law enforcement agencies, including the U.S. Drug Enforcement Administration (DEA), have amped up their investigations into the drug ketamine in recent years, likely in reaction to some high-profile overdose deaths....more
8/1/2024
/ Controlled Substances ,
Controlled Substances Act ,
DEA ,
Defense Strategies ,
Drug Possession ,
Government Investigations ,
Health Care Providers ,
Internal Investigations ,
Litigation Strategies ,
Physicians ,
Prescription Drugs ,
Risk Assessment ,
Risk Mitigation ,
White Collar Crimes
Recently, the U.S. Food and Drug Administration (FDA) confirmed that it is investigating allegations that a 60 Minutes segment on the popular body weight loss drug Wegovy was actually an advertisement promoting the...more
4/19/2023
/ Advertising ,
Criminal Prosecution ,
Enforcement Actions ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Investigations ,
Marketing ,
Novo Nordisk ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians ,
Prescription Drugs
As a doctor or other licensed medical professional, the prospect of losing your license to practice medicine can be overwhelming. But, to protect your license—and your career—to the fullest extent possible, you need to act...more
3/21/2023
/ Defense Strategies ,
Health Care Providers ,
Healthcare Fraud ,
Investigations ,
Licensing Boards ,
Medical License ,
Medical Malpractice ,
Physicians ,
Professional Disciplinary Actions ,
Professional Liability Insurance ,
Professional Responsibility ,
State Medical Board
The U.S. Department of Justice (DOJ) has recently taken a renewed interest in management services organizations (MSOs), including physician-syndicated MSOs in which physician-owners provide medical services in exchange for...more
As a licensed physician, facing a medical board investigation could mean that your career is on the line. Even though you spent years in medical school and in residency, and even though you may have spent decades honing your...more
As a licensed physician in Texas, facing a Texas Medical Board (TMB) investigation can entail significant risks. Depending on the allegations underlying the investigation, your medical license could be in jeopardy—and you...more
Yesterday, the U.S. Department of Justice (DOJ) announced that it has filed charges against 36 defendants in relation to an alleged health care fraud scheme that resulted in approximately $1.2 billion in fraudulent payments....more
7/21/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Enforcement Actions ,
FBI ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Medicare Beneficiaries ,
Physician Medicare Reimbursements ,
Physicians ,
Telehealth ,
Telemarketing ,
Telemedicine
Targeted Probe and Educate (TPE) audits have recently become a common tool used by both law enforcement and private insurers in the Medicare program. While they focus on educating Medicare providers about proper billing...more
6/21/2022
/ Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Criminal Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Medical Billing Codes ,
Medical Records ,
Medicare ,
Medicare Administrative Contractors (MAC) ,
Medicare Appeals ,
Medicare Fraud ,
Penalties ,
Physicians ,
Targeted Probe and Education (TPE) audit
Clinical laboratories have come under increased scrutiny in the past few years, especially those that deal with COVID-19 testing or drug testing.
These federal investigations can be surprising and confusing for lab...more
4/5/2022
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Liability ,
CLIA ,
Clinical Laboratories ,
Criminal Liability ,
Defense Strategies ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
FBI ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Healthcare Fraud ,
Investigations ,
OIG ,
Penalties ,
Physicians ,
Stark Law
In many ways, the COVID-19 pandemic increased the business opportunities available to clinical labs, including molecular and respiratory labs. As the nation—and the world—struggled to develop adequate testing infrastructure,...more
1/19/2022
/ Audits ,
Clinical Laboratories ,
Coronavirus/COVID-19 ,
Defense Strategies ,
Department of Health and Human Services (HHS) ,
FBI ,
Health Care Providers ,
Healthcare Fraud ,
Investigations ,
Medical Billing Codes ,
Medical Necessity ,
OIG ,
Patient Referrals ,
Physicians
The federal government has recently made clear its intention to go after healthcare providers who provide amniotic injections to certain Medicare and Medicaid recipients. Over recent years, the federal government has...more
10/26/2021
/ Anti-Kickback Statute ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Investigation Demand ,
Civil Liability ,
Criminal Liability ,
Defense Strategies ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
False Claims Act (FCA) ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Physicians ,
Stark Law
Durable medical equipment (DME) is particularly important for many Medicare beneficiaries. However, companies that manufacture and sell DME need to be careful because there are strict federal regulations outlining almost...more
7/28/2021
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Chief Compliance Officers ,
Civil Liability ,
Compliance ,
Compliance Commitees ,
Corrective Action Plans (CAPs) ,
Criminal Liability ,
Department of Health and Human Services (HHS) ,
Disciplinary Proceedings ,
Durable Medical Equipment ,
Employee Training ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
OIG ,
Physicians ,
Policies and Procedures ,
Standard of Conduct ,
TRICARE
The U.S. Department of Justice (DOJ) is cracking down on healthcare fraud, and many providers are finding themselves facing serious allegations. This includes criminal allegations in many cases. If these allegations lead to a...more
6/8/2021
/ Arraignment ,
Criminal Prosecution ,
Defense Strategies ,
Department of Justice (DOJ) ,
Discovery ,
Evidence ,
Federal Prosecutors ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Indictments ,
Motion to Dismiss ,
Physicians ,
Plea Negotiations ,
Pre-Trial Motions ,
Preliminary Hearings
Medicare pays billions of dollars in fraudulently billed claims each year despite the various tools the Medicare system has at its disposal. Because of this problem, the Centers for Medicare and Medicaid Services (“CMS”)...more
4/6/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Defense Strategies ,
Documentation ,
False Billing ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
MACs ,
Medicare ,
Physicians ,
Recovery Audit Contractors (RACs)
The COVID-19 pandemic has created many new enforcement priorities for the U.S. Department of Justice (DOJ). From selling ineffective personal protective equipment (PPE) to companies fraudulently seeking loan forgiveness under...more
3/30/2021
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Controlled Substances ,
Controlled Substances Act ,
Coronavirus/COVID-19 ,
DEA ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Prescribing ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
FBI ,
Health Care Providers ,
Health Clinics ,
Healthcare Fraud ,
Medical Necessity ,
OIG ,
Opioid ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians ,
Policies and Procedures ,
Prescription Drugs ,
Stark Law
The Office of Inspector General is a division of the U.S. Department of Health and Human Services that is tasked with combating fraud committed against Medicare, Medicaid, and other federally funded government programs. The...more
3/10/2021
/ Clinical Laboratories ,
Compliance ,
Compliance Monitoring ,
Corrective Action Plans (CAPs) ,
Dentists ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Hospitals ,
Internal Audit Functions ,
Medicaid ,
Medical Billing Codes ,
Medicare ,
Nursing Homes ,
OIG ,
Pharmacies ,
Physicians ,
Policies and Procedures
Everything else in the world has changed, why not how we treat our doctors? If a doctor can only bill for a two-minute telemedicine consultation, why should that doctor be held to the ordinary standard of care? If insurance...more
Most health care providers have at least a basic understanding of the Anti-Kickback Statute. This federal law prohibits providers from offering, paying, soliciting, or accepting any form of “remuneration” for patient...more
12/11/2020
/ Anti-Kickback Statute ,
Civil Liability ,
Clinical Laboratories ,
Criminal Liability ,
Criminal Penalties ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Facilities ,
Medicaid ,
Medicare ,
Medicare Part D ,
Noncompliance ,
Patient Referrals ,
Physicians ,
Policies and Procedures ,
Stark Law
As a doctor, allegations of medical malpractice or other unlawful or unethical conduct can have wide-ranging implications. In addition to facing civil liability and the prospect of a significant increase in your medical...more
11/11/2020
/ Administrative Law Judge (ALJ) ,
Defense Strategies ,
Health Care Providers ,
Healthcare Fraud ,
License Suspensions ,
Licensing Boards ,
Medical License ,
Medical Malpractice ,
Physicians ,
Professional Disciplinary Actions ,
Professional Misconduct ,
Revocation ,
Settlement