News & Analysis as of

Healthcare Fraud

Scrutiny Increases on Healthcare Providers in Central Florida

In the past month, the U.S. Attorney's Office for the Middle District of Florida--the primary federal law enforcement authority in Central Florida--has announced a series of healthcare-fraud related developments. These...more

Private Equity Firm Named As Defendant In False Claims Act Case Targeting A Portfolio Company

A recent complaint filed by the United States against a private equity firm regarding an alleged kickback further illustrates new concerns private equity should be aware of in the healthcare arena and working with counsel to...more

False Claims Act/Qui Tam Whistleblower Litigation Involving Health Care Providers: United States of America v. BlueWave Healthcare...

United States of America, et al. v. BlueWave Healthcare Consultants, Inc., et al. (9:14-cv-00230-RMG) is a significant qui tam action recently tried to a jury before Judge Richard Gergel in the District of South Carolina....more

Court Declines to Allow Defendants in Fraud Scheme to Utilize 28 U.S.C. § 2255 or Writ of Coram Nobis to Challenge Order of...

In United States v. Rutigliano, No. 16-3754 et al., the Second Circuit (Jacobs, Raggi, Droney) refused to endorse the reduction of a restitution order against defendants who had conspired to submit fraudulent disability...more

State Enforcement Actions Demonstrate Continued Scrutiny of Health Care Fraud

A series of criminal and civil enforcement actions announced in recent weeks demonstrate the continued attention that state regulators throughout the Northeast are placing on health care fraud. ...more

OIG Advisory Opinion 18-01: Excluded Individual May Serve as Marketing Liaison to LTC Pharmacies

by Baker Ober Health Law on

In OIG Advisory Opinion 18-01, published February 27, 2018, the OIG concluded a proposed employment arrangement between an excluded individual and a for-profit company selling discounted emergency medications to long term...more

Launch of the Criminal Division’s In-House Health Care Data Analytics Team

by Dickinson Wright on

In its “2017 Year in Review”, the Fraud Section in the Criminal Division of the US Department of Justice announced the launch of its Health Care Fraud Unit’s Data Analytics Team. ...more

Costs Increase for Health Care Fraud and Abuse Violations

by Baker Ober Health Law on

Recent congressional action will have serious ramifications on corporate and individual defendants who are or could be under investigation for violations of federal health care program fraud and abuse laws. Changes...more

Health Care Investigation Trends: Corporate Integrity Agreements No Longer a Given

2017 was slightly above average for new corporate integrity agreements (CIAs), with 46 entered into by the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) and companies and individuals...more

United States Intervenes in Suit Against Private Equity Firm Based on Health Care Portfolio Company's Alleged False Claims Act...

• In an unusual move, the government has decided to pursue a False Claims Act (FCA) suit against a private equity firm based on an alleged commission scheme at its pharmacy portfolio company to promote sales of products...more

Civil and criminal penalties increased for fraud and abuse

by Bricker & Eckler LLP on

The Bipartisan Budget Act of 2018 (BBA 2018) significantly increased civil and criminal penalties for federal health care program fraud and abuse. Below is a summary of some of the BBA 2018 changes to the maximum penalty...more

Continuing Resolution Creates Significant Changes to Medicare and Medicaid Policies

by Polsinelli on

The Bipartisan Budget Act of 2018, commonly referred to as the “Continuing Resolution,” was recently signed into law, creating a short-term fix to funding the federal government for six weeks while also raising the debt...more

Health Care Investors Beware: U.S. Attorney Sues Private Equity Firm For Portfolio Company’s Alleged Billing Fraud

The U.S. Attorney for the Southern District of Florida has recently decided to intervene in a lawsuit brought under the Federal False Claims Act and initiated by a whistleblower. The U.S. Attorney has filed his own...more

Recent Healthcare Fraud Suit Puts Private Equity Industry on Notice as to Potential Liability for Portfolio Company Conduct

by White and Williams LLP on

In February, the Department of Justice (DOJ) intervened in a False Claims Act case alleging healthcare fraud, a common enough event. The case in question, originally began in 2015 as a whistleblower case brought by two...more

Recent Anti-Kickback Cases Emphasize Government Scrutiny of Speaker’s Bureaus and Lavish Meals Funded by Pharmaceutical and Device...

The Department of Justice (DOJ) recently resolved two health care fraud cases – one criminal and one civil – that demonstrate the government’s continued scrutiny of lavish meals and “speaker’s bureaus” sponsored by...more

Bipartisan Budget Act Revises Stark Law, Increases Penalties for AKS and CMP Law Violations, and Expands Telehealth Coverage

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 (the Act), which included a number of important health law provisions.. ...more

Recent FCA Settlement Shows That What’s Old Is New in Health Care Fraud Enforcement

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

Healthcare Fraud & Abuse Review 2017

by Bass, Berry & Sims PLC on

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

DOJ Memoranda Ushering in New Era for Health Care Enforcement

by Foley & Lardner LLP on

In January 2018, the Department of Justice (DOJ) issued two memoranda that, taken together, may usher in a new era of False Claims Act (FCA) enforcement in the health care industry. The first memorandum, dated January 10,...more

Third Circuit Affirms Dismissal of FCA Claim Premised Upon Alleged Anti-Kickback Scheme, While Clarifying that Plaintiffs Need Not...

The Third Circuit’s decision in Medco Health Solutions, affirming the dismissal of a relator’s qui tam suit against his former employer, offers mixed news for False Claims Act defendants and plaintiffs as to the kind of...more

DOJ Intervenes in False Claims Act Case Against a Compounding Pharmacy and Private Equity Firm

The Department of Justice (DOJ) recently intervened in a False Claims Act (FCA) case that raises a variety of interesting allegations, including payment of kickbacks by a compounding pharmacy to contracted marketing companies...more

False Claims Act 2017 Report Card: $2.4 Billion Recovered

by Shipman & Goodwin LLP on

On December 21, 2017, the Department of Justice (DOJ) issued its yearly report card describing its most noteworthy settlements in fiscal year 2017 with healthcare providers under the False Claims Act (FCA).1 In addition to...more

Have You Properly Prepared for a WPA Audit?

by FordHarrison on

Audits of compliance with the Wage Parity Act ("WPA") are on the rise. The NYS Attorney General's Medicaid Fraud Unit, Medicaid Inspector General ("OMIG"), and Department of Labor ("DOL") are all auditing home care agencies....more

The Government’s Use of Data Analytics to Identify Healthcare Fraud

by Blank Rome LLP on

No one knows exactly how much fraudulent conduct costs the United States healthcare system. Some suggest it may cost Medicare, Medicaid, and private insurers $100 billion each year. Regardless of the exact amount, everyone...more

DOJ Pursues PE Firm Based on Portfolio Company's Alleged Payment of Kickbacks

by Jones Day on

The Situation: In what may indicate a sea change in terms of who the Department of Justice ("DOJ") is willing to pursue in False Claims Act cases, a private equity firm has been named as a co-defendant in a False Claims Act...more

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