For the last few years, we have been closely monitoring and reporting on COVID-19 related fraud enforcement efforts by federal agencies. We detailed those findings in our Health Care Enforcement 2020 Year in Review & 2021...more
4/29/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Defense (DOD) ,
Department of Justice (DOJ) ,
Department of Labor (DOL) ,
Department of the Interior ,
Enforcement Actions ,
Enforcement Authority ,
FBI ,
Food and Drug Administration (FDA) ,
Fraud ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Medical Billing Codes ,
Medicare ,
OIG ,
Provider Relief Fund ,
Telemedicine ,
USPS
STATISTICAL TRENDS IN FALSE CLAIMS ACT LITIGATION -
FCA case activity for 2021 reveals seemingly contrary trends. For the federal fiscal year (FY) that ended September 30, 2021, the DOJ annual report on FCA enforcement...more
2/11/2022
/ Clinical Trials ,
Coronavirus/COVID-19 ,
Cybersecurity ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medical Devices ,
Medicare ,
Medicare Advantage ,
Nursing Homes ,
Pharmaceutical Industry ,
Pharmacies ,
Qui Tam ,
Telehealth
As our readers know, we have long been closely watching False Claims Act (FCA) cases across the country alleging the submission of false claims based on the lack of medical necessity, particularly as a possible circuit split...more
On March 16th, Attorney General William Barr issued a memorandum to all United States Attorneys directing each U.S. Attorney’s Office (USAO) to “prioritize the detection, investigation, and prosecution of all criminal conduct...more
4/7/2020
/ Anti-Kickback Statute ,
Conspiracies ,
Coronavirus/COVID-19 ,
Criminal Investigations ,
Department of Justice (DOJ) ,
Enforcement Programs ,
Genetic Testing ,
Healthcare ,
Healthcare Fraud ,
Illegal Profits ,
Kickbacks ,
Public Health ,
U.S. Attorney ,
Virus Testing
As many of our readers know, the AseraCare case was closely watched over the last several years because of its significance to efforts by the Department of Justice (DOJ) to allege that submission of claims for services...more
On Monday, the U.S. Court of Appeals for the Eleventh Circuit issued its long-awaited and closely watched decision in United States v. AseraCare Inc.. The court ruled that a claim cannot be deemed false under the False Claims...more
9/12/2019
/ Defense Strategies ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospice ,
Medical Necessity ,
Motion for Summary Judgment ,
Physicians ,
Qui Tam ,
Relators ,
Remand ,
Sua Sponte
WHAT’S INSIDE -
Who Decides How Bankruptcy Laws Are Applied?
PROMESA: An Experiment Doomed to Fail -
The Role of Alter Ego in Restructuring -
SPECIAL FRAUD SECTION -
Don’t Depend on a Handshake -
Health...more
4/25/2019
/ Department of Justice (DOJ) ,
False Claims Act (FCA) ,
FRCP 9(b) ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Motion to Dismiss ,
Petition for Writ of Certiorari ,
Qui Tam ,
Relators
As many of our readers know, we have been closely following the Polukoff False Claims Act (FCA) qui tam case, which is based on allegations that certain heart procedures performed by a cardiologist were not medically...more
2/8/2019
/ Appointments Clause ,
Article II ,
Denial of Rehearing ,
Failure to Comply ,
False Claims Act (FCA) ,
FRCP 9(b) ,
Health Care Providers ,
Healthcare Fraud ,
Medicare ,
Petition for Writ of Certiorari ,
Split of Authority ,
Whistleblowers
In a three-sentence order issued on October 29th, the Tenth Circuit Court of Appeals declined to grant a Request for Rehearing in the closely watched Polukoff case. One of the questions raised in the Request was whether, by...more
Last week, the U.S. Attorney’s Office for the District of Massachusetts announced that it had entered into an agreement with a Massachusetts-based medical device manufacturer to settle allegations that the Company had...more
As we predicted in our year-end post on civil and criminal enforcement trends, 2018 is already off to strong start in opioid-related enforcement against individual providers and associated practices. Earlier this month, the...more
2/20/2018
/ Controlled Substances Act ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Enforcement Actions ,
Health Care Providers ,
Healthcare Fraud ,
Medicare ,
Opioid ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians
Like many before it, this year has been one to watch in government health care fraud enforcement efforts. In September 2015, the Department of Justice (DOJ) released the “Yates Memo,” which reaffirmed the government’s...more
6/28/2016
/ Acquittals ,
Affirmative Defenses ,
Anti-Kickback Statute ,
Corporate Counsel ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Good Faith ,
Healthcare Fraud ,
Jury Instructions ,
Kickbacks ,
Pharmaceutical Industry ,
Popular ,
Yates Memorandum
Trends & Analysis -
Since our last Qui Tam Update, we have identified 39 health-related False Claims Act (“FCA”) qui tam cases that have been unsealed. Of those cases...more
9/22/2015
/ ACOs ,
Anti-Kickback Statute ,
Controlled Substances ,
False Billing ,
False Claims Act (FCA) ,
Falsified Documents ,
Former Employee ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Internal Controls ,
Medicaid ,
Medicare ,
Medicare Shared Savings Program ,
Physicians ,
Prescription Drugs ,
Qui Tam ,
Relators ,
Retaliation ,
Settlement ,
State False Claims Acts ,
Stipulations ,
Third-Party Service Provider ,
TRICARE ,
Whistleblowers ,
Wrongful Termination
This past Friday, hospital company HCA Holdings, Inc. asked a federal court judge to dismiss a False Claims Act (FCA) suit filed by whistleblower and former employee, Stephen McMullen. Mr. McMullen worked for an...more