News & Analysis as of

Fraud and Abuse

Arnall Golden Gregory LLP

HHS OIG Advisory Opinion 25‑12: Recruiting Bonuses for Family‑Care Attendants Trigger AKS and Beneficiary Inducements CMP Risk

Key Takeaways - Targeted recruiting that doubles as patient acquisition is high‑risk. When a home health agency’s prospective employee is a Medicaid beneficiary’s surrogate decision‑maker, advertising a sign-on bonus can...more

Rivkin Radler LLP

OIG Gives Thumbs Down to Payment of Sign-On Bonuses by Home Care Agency

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In an unfavorable Advisory Opinion issued last week, the Office of Inspector General, U.S. Department of Health and Human Services (OIG) found that a home care agency’s plan to market sign-on bonuses to prospective employees...more

Rivkin Radler LLP

Diagnostic Lab to Pay $9.6 Million to Settle FCA/AKS Allegations

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The U.S. Department of Justice recently announced a settlement with Patients Choice Laboratories (“PCL”), a diagnostic laboratory headquartered in Indianapolis, Indiana, under which PCL will pay over $9.6 million to resolve...more

Rivkin Radler LLP

NYS Cracks Down on Medical Transportation Companies for Fraud

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In October, two medical transportation companies were charged with or indicted for fraud in New York. The owner of Pearl Transit Corp. (“Pearl”), Jael Watts, was accused of running a sham transportation service that...more

Health Care Compliance Association (HCCA)

[Event] Managed Care Compliance Conference - February 2nd - 3rd, Chandler, AZ

Insight, innovation, and practical strategy for professionals in the managed care space - Compliance professionals in managed care face an ever-changing landscape shaped by evolving regulations, emerging risks, and...more

Fox Rothschild LLP

Strict Compliance with Safe Harbor Requirements is Key to Avoiding Anti-Kickback Violations

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Office of Inspector General (“OIG”) Advisory Opinion 25-09[1] addresses an inquiry from a company that develops, manufactures and sells medical devices used in emergency stroke treatment and provides commentary for similarly...more

American Conference Institute (ACI)

[Event] 42nd Annual Conference on FCPA and Global Anti-Corruption - December 3rd - 4th, National Harbor, MD

Join over 700 professionals at the forefront of FCPA and anti-corruption strategy at ACI's 42nd Annual Conference on FCPA and Global Anti-Corruption, as they explore what’s next for compliance, ethics, and enforcement. Get...more

Health Care Compliance Association (HCCA)

[Virtual Event] Healthcare Enforcement Compliance Conference - October 29th - 30th, 8:00 am - 5:00 pm CT

Navigate the current enforcement landscape with expert guidance - The Healthcare Enforcement Compliance Conference brings together experienced attorneys and consultants, compliance professionals, and leading experts in...more

Harris Beach Murtha

[Webinar] Fraud and Abuse Enforcement in Health Care - October 6th, 10:00 am ET

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Please join the Harris Beach Murtha Health Care Industry Team for an engaging and informative webinar designed for health care professionals, legal teams and industry leaders. Our panel of experienced attorneys will explore...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

Rare Circuit Court Decision on Eliminating Kickbacks in Recovery Act Demands Notice In and Beyond Addiction Treatment Industry

The Ninth Circuit recently decided United States v. Schena, 142 F.4th 1217 (9th Cir. 2025), which considered the Eliminating Kickbacks in Recovery Act (“EKRA”). EKRA, enacted in 2018 to address “body brokering” and other...more

Wilson Sonsini Goodrich & Rosati

Offering Equity to Physicians in an MSO/PC Structure: Key Fraud and Abuse Compliance Considerations

Executive Summary - - Offering equity in MSOs to physicians can be permissible but must be structured to comply with both federal and state laws. Failure to comply with applicable fraud and abuse laws may result in civil...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

New Jersey Enacts Key Legislation Addressing Kickbacks and Deceptive Marketing Practices in the Substance Use Disorder Treatment...

On August 11, 2025, New Jersey’s Acting Governor, Tahesha Way, signed into law two bills to combat patient brokering and deceptive marketing practices in the Substance Use Disorder (“SUD”) treatment industry. The legislation,...more

Arnall Golden Gregory LLP

“Longstanding and Clear”: OIG Continues Characteristic Close Scrutiny of Below-Market Benefits to Referral Sources

The United States Department of Health and Human Services, Office of Inspector General (“OIG”) recently released two unfavorable advisory opinions, OIG Advisory Opinion No. 25-04 and -08 (the “Opinions”) to medical device...more

Venable LLP

EKRA Has Teeth: Ninth Circuit Upholds Lab Operator’s Criminal Conviction for Paying Marketers for Referrals

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In a matter of first impression, the Ninth Circuit Court of Appeals interpreted the scope of the 2018 Eliminating Kickbacks in Recovery Act (EKRA) in the context of a lab operator who allegedly paid marketers to induce...more

Morgan Lewis - Health Law Scan

OIG’s Advisory Opinion No. 25-08: Negative Opinion Highlights Potential Broad Reach of AKS

In a relatively rare move, the US Department of Health and Human Services Office of Inspector General (OIG) recently issued an unfavorable Advisory Opinion (No. 25-08) (Opinion) reinforcing the agency’s expansive view of the...more

Orrick, Herrington & Sutcliffe LLP

4 Healthcare Regulatory Fundraising Fundamentals

Jeremy Sherer and Thora Johnson share insight on: Key due diligence considerations for healthtech companies State and federal regulations aimed at virtual care delivery...more

Troutman Pepper Locke

HHS Sets Its Sights on $50B in Cost Savings: Medicare Payments to Nonhospice Providers Potentially Under Fire

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In May 2025, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a review, titled “Potential Cost Savings HHS Programs – HHS Actions,” which provided some insight into the OIG’s...more

Hogan Lovells

OIG issues two unfavorable decisions, cautions against some customer service fees paid by manufacturers

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The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued two unfavorable decisions in Advisory Opinions (AOs) 25-04 and 25-08 (the “Opinions”), finding that some service fees paid by...more

Sheppard Mullin Richter & Hampton LLP

Inside the Ninth Circuit’s Interpretation of EKRA: Clarity for Kickback Law

On July 11, 2025, in United States v. Schena,[1] the Ninth Circuit adopted an expansive interpretation of the Eliminating Kickbacks in Recovery Act (EKRA), applying the law to any payment that could have the effect of...more

Stinson LLP

Federal Government Initiatives Combat Fraud and Promote Digitalization of Payments

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Continuing the war on fraud and the attendant financial losses for U.S. businesses, consumers and government alike, the U.S. Department of the Treasury and federal banking agencies have launched a wide-ranging initiative...more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | April 2025 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for April 2025, including Centers for Medicare & Medicaid Services (CMS) updates to Medicare Advantage (MA) and other Medicare programs....more

Foley Hoag LLP

DOJ Announces New Priorities in White-Collar Criminal Enforcement: Targeting Waste, Fraud, and Abuse and Protecting American...

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The U.S. Department of Justice’s ("DOJ") Criminal Division recently issued a memorandum outlining a shift in the DOJ’s priorities and policies for prosecuting white-collar crime (the “Memorandum”). Issued by the Head of the...more

Bradley Arant Boult Cummings LLP

SEC Enforcement Leadership Discusses New Priorities and Expectations

On May 20, 2025, as part of the annual “SEC Speaks” program, the leadership of the U.S. Securities and Exchange Commission’s (SEC) Division of Enforcement publicly discussed the enforcement priorities under new Chairman Paul...more

DarrowEverett LLP

The DOJ’s New White-Collar Agenda: Implications for Businesses

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On May 12, 2025, the Department of Justice (the “DOJ”) released its criminal—and, more specifically, white collar crime enforcement—initiatives under the current administration. This is typical each time new leadership...more

Carlton Fields

Shifting Priorities in White Collar Enforcement: May 2025 DOJ Memo and What It Means for Companies

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On May 12, 2025, the Department of Justice (DOJ) Criminal Division announced significant changes in its policies on investigating and prosecuting white collar crime, including a shift in focus toward several areas deemed to...more

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