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Hospitals Fraud

McGuireWoods LLP

Medical Device Legal News with Sam Bernstein: Episode 11

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A former DePuy Synthes sales representative is arrested for allegedly defrauding a hospital into submitting claims for products not actually used in surgery; A number of additional clinics enter into settlements to resolve...more

Robinson+Cole Health Law Diagnosis

Connecticut Expands Applicability of State False Claims Act

On June 26, 2023, Connecticut Governor Ned Lamont signed into law Public Act 23-129: “An Act Concerning Liability for False and Fraudulent Claims” (the Act). The Act expands application of Connecticut’s False Claims Act...more

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | March 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for March 2023. We discuss several criminal and civil enforcement actions that involve Anti-Kickback Statute (AKS) and...more

Smith Gambrell Russell

How A Hospital Can Assure That It Will Be Required To Pay Punitive Damages

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During the federal fiscal year ending in September, 2022, the Department of Justice collected more than $1.7 billion in False Claims Act (FCA) settlements and judgments involving fraud in Medicaid, Medicare Advantage (MA)...more

Husch Blackwell LLP

DOJ Continues to Eye Clinical Researchers (and the Universities and Hospitals Employing Them)

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Last month, The Economist published a call to action titled, “There is a worrying amount of fraud in medical research: And a worrying unwillingness to do anything about it.” The article is the latest in a sequence of alarms...more

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | January 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity and developments occurring in January 2023, including several criminal and civil enforcement actions related to the federal...more

Gardner Law

Anti-Fraud & Sunshine Update

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Staying up-to-date with fraud enforcement trends and recent cases and settlements can sometimes be viewed as a “Glass Half Empty” perspective, focusing on negative aspects of the industry and the perceived threat of...more

Bass, Berry & Sims PLC

OIG Declines to Approve Lab’s Payment of Specimen Collection Fees to Hospitals

On April 28, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services published Advisory Opinion 22-09, declining to approve a laboratory company’s proposal to pay hospitals a fair market...more

Bass, Berry & Sims PLC

2021 Recap: Hospitals’ Significant False Claims Act Settlements

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Each year, the Department of Justice (DOJ) recovers millions of dollars through False Claims Act (FCA) settlements, and 2021 was no exception. Some of the most sizeable or otherwise noteworthy settlements from 2021 were with...more

ArentFox Schiff

Texas Hospital to Pay Over $3 Million to Resolve False Claims Act Allegations

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John Peter Smith Hospital (JPS) agreed to pay more than $3.3 million to settle allegations that it violated the False Claims Act by upcoding hundreds of claims submitted to federal healthcare programs. Texas Hospital to...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 25. News Briefs: July 2020

Report on Medicare Compliance 29, no. 25 (July 13, 2020)  -  Ophthalmic Consultants PA in Sarasota, Florida, agreed to pay $4.8 million to settle false claims allegations that it billed Medicare and other federal payers...more

Rosenberg Martin Greenberg LLP

Avoiding Conflicts of Interest: Lessons Learned from the UMMS-Healthy Holly Scandal

June 2020 marked a critical milepost in Catherine Pugh’s long road to redemption. On June 19, the disgraced former mayor of Baltimore pleaded guilty to a state misdemeanor perjury charge for her failure to disclose her...more

Foley Hoag LLP - White Collar Law &...

Federal Prosecutors Ask Massachusetts Hospitals to Help Root Out Fraud Related To COVID-19

The United States Attorney for the District of Massachusetts is proactively seeking to find, investigate, and prosecute unlawful attempts to exploit the COVID-19 pandemic and is asking hospitals to assist. U.S. Attorney...more

King & Spalding

Ninth Circuit Holds That Medical Opinions Do Not Automatically Preclude FCA Liability at the Pleading Stage

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In late March, the United States Court of Appeals for the Ninth Circuit revived a whistleblower lawsuit under the False Claims Act (FCA) in which a former employee accused a healthcare provider of submitting reimbursement...more

Dorsey & Whitney LLP

Escobar in Action: Physician-owners’ fraud claims against hospital defeated in Fifth Circuit appeal for lack of materiality

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Following the passage of the Affordable Care Act (“ACA”), which placed new limits on physician-owned hospitals, St. Luke’s Health System (“System”) took action to change one of its hospital’s ownership structures through a...more

Benesch

Benesch Market Intelligence: Health Care Quarterly Report - Q3 2019

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Shepherd Premier Aims to Open 30 Small-Home Communities By 2022 - Aug 11th, 2019 via Senior Housing News. Small-home senior living provider, Shepherd Premier Senior Living, offers an alternative to traditional large-scale...more

ArentFox Schiff

Investigations Newsletter: 34 Individuals Charged in $258 Million Medicare and Medicaid Fraud Schemes

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34 Individuals Charged in $258 Million Medicare and Medicaid Fraud Schemes - Twenty-six individuals in the state of California, fourteen of whom were doctors or medical professionals, and eight individuals in Arizona and...more

Manatt, Phelps & Phillips, LLP

Health Update - November 2017

Fraud and Abuse 2017: Understanding Trends and Avoiding Actions - Editor’s Note: In a recent webinar for Bloomberg BNA, Manatt examined game-changing fraud and abuse trends and cases—and revealed strategies for avoiding...more

King & Spalding

Hospital and Medical Group Settle Stark Law Case for $20.75 million

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A Pennsylvania hospital and physician group settled whistleblower fraud allegations for $20.75 million the day before jury selection was set to begin in U.S. District Court of the Western District of Pennsylvania in a suit...more

Bass, Berry & Sims PLC

FCA Deeper Dive: Pleading the Alleged Fraud Scheme

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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

Poyner Spruill LLP

U.S. Department of Justice Issues New Guidance on Evaluation of Corporate Compliance Programs

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On February 8, 2017, the Fraud Section of the U.S. Department of Justice (DOJ) published new guidance titled “Evaluation of Corporate Compliance Programs” (Compliance Guidance), which can be found at...more

Sheppard Mullin Richter & Hampton LLP

Jury Returns Massive Verdict in Hospital Gown Fraud Lawsuit

On Friday, April 8, 2017, a federal jury in California sent shockwaves throughout the healthcare and legal community when it returned a $454 million verdict against Kimberly-Clark Corp. and its affiliate Halyard Health Inc....more

Mintz - Health Care Viewpoints

Another Court Agrees That A Difference Of Opinion On Medical Necessity Is Insufficient to Show Falsity Under the False Claims Act

Last month, the U.S. District Court for the District of Utah joined the AseraCare court and others in finding that a relator cannot successfully allege violations of the False Claims Act (“FCA”) based on a purported lack of...more

Snell & Wilmer

You’re Fired: What Impact Will Sally Yates’ Departure Have on the DOJ’s Fraud Enforcement?

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As most of the world now knows, President Trump fired acting Attorney General Sally Yates last week after she declined to defend the President’s travel ban. Dana Boente has replaced Ms. Yates, but he may not be long for the...more

Patrick Malone & Associates P.C. | DC Injury...

South Dakota high court won’t force hospitals to disclose why they let a bad doctor operate on patients’ spines

South Dakotans will need their state lawmakers’ help now to pry open physicians’ iron grip on secret decisions about which doctors get to practice in hospitals and why. That’s because the state’s Supreme Court ruled this...more

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