News & Analysis as of

Unnecessary Medical Procedures False Claims Act (FCA)

Rivkin Radler LLP

Brooklyn Cardiologist Hit with Fraud Charges

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On December 14, the U.S. Attorney’s Office for the Southern District of New York and other agencies announced the indictment of Niranjan Mittal, a Brooklyn cardiologist, on multiple fraud charges. Mittal allegedly fabricated...more

Cozen O'Connor

$1.45 Million Settlement is a Bitter Pill to Swallow

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North Carolina AG Josh Stein settled with Med First Immediate Care and Family Practice, P.A. to resolve False Claims Act allegations that the clinic operated as a “pill mill” for opioid prescriptions....more

Rivkin Radler LLP

FCA Complaint Filed Against Interventional Radiologist

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On May 2, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced that the United States has filed a complaint under the False Claims Act (FCA) against James McGuckin, an interventional radiologist. The...more

Proskauer - Health Care Law Brief

Another Unique Integrity Agreement Signals a Trend towards HHS-OIG’s Comfort with a Belt and Suspenders

In recent years, there have been only a handful of corporate integrity agreements (“CIAs”) and integrity agreements (“IAs”) that have included a “conditional exclusion release” of the Office of the Inspector General for the...more

Rivkin Radler LLP

Fraud Week: Kickbacks for Home Healthcare Referrals

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The U.S. Department of Justice (DOJ) announced on October 18 that Oklahoma-based Carter Healthcare LLC and its affiliates, plus two executives, agreed to pay a total of over $30 million to resolve two separate qui tam cases....more

Rivkin Radler LLP

Fraud Week: Medically Unnecessary Pediatric Root Canals

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The U.S. Attorney for the District of New Jersey and New York Attorney General Letitia James both announced on October 6 that pediatric dentist Barry L. Jacobson, his management company, and 13 affiliated pediatric dentistry...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 31, Number 14. News Briefs: April 2022

Report on Medicare Compliance 31, no. 14 (April 18, 2022) - Michigan gynecologic oncologist Vinay Malviya, M.D., has agreed to pay $775,000 to settle false claims allegations in connection with medically unnecessary...more

Wiley Rein LLP

2021 FCA Recoveries Bounce Back from Decade-Low . . . Maybe

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On February 1, the U.S. Department of Justice (DOJ) announced the second-largest annual total recoveries in the history of the False Claims Act (FCA)—$5.6 billion—for FY 2021 (October 2020 – September 2021)...more

Cozen O'Connor

Notice of Appeal - A quarterly newsletter reviewing Third Circuit opinions impacting white collar defense lawyers - Winter 2022

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Defendants Cannot Move for Compassionate Release Based Solely on Post-Sentencing Cooperation- United States v. Claude (October 27, 2021), No. 20-3563- BACKGROUND- Defendant sought compassionate release to reduce his...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 15. News Briefs: April 2020 #2

Report on Medicare Compliance 29, no. 15 (April 20, 2020) - Maury Regional Medical Center in Tennessee has agreed to pay $1.7 million to settle false claims allegations over MS-DRG coding, the U.S. Attorney’s Office for...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 7. News Briefs: February 2020 #4

Report on Medicare Compliance 29, no. 7 (February 24, 2020) -  Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 6. News Briefs: February 2020 #3

Report on Medicare Compliance 29, no. 6 (February 17, 2020) - Tenet Healthcare Corp. and an affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.41 million to settle False Claims Act (FCA)...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 28, Number 41. News Briefs - November 2019 #3

Report on Medicare Compliance 28, no. 41 (November 18, 2019) - -  North Carolina physician Damian Brezinski and his medical group, Wilmington Health, agreed to pay $244,000 to settle false claims allegations in connection...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 28, Number 37. News Briefs - October 2019 #2

California physician Donald Woo Lee was found guilty Oct. 17 for his role in providing medically unnecessary procedures to Medicare beneficiaries, upcoding, and repackaging single-use catheters for re-use, the Department of...more

McGuireWoods LLP

Healogics Settles False Claims Case Involving Allegations of Medically Unnecessary Procedures

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The United States Attorney’s Office for the Middle District of Florida recently settled a False Claims Act case against Healogics, Inc. (“Healogics”) in which it was alleged that Healogics had knowingly billed Medicare for...more

Pillsbury Winthrop Shaw Pittman LLP

A “Change of Heart” in a Health Care Fraud Prosecution - Inconsistent angiogram interpretations establish reasonable doubt in...

On March 7, 2017, the U.S. District Court for the Eastern District of Kentucky reversed the October 27, 2016 criminal jury verdict against Kentucky cardiologist Dr. Richard E. Paulus, and acquitted him on all counts of health...more

Ruder Ware

Chiropractic Service Overpayment for Lack of Medical Necessity

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Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic...more

Bass, Berry & Sims PLC

Failure to Plead Objective Falsity Dooms Cardiologist’s FCA Complaint

A number of recent FCA decisions have grappled with the question of objective falsity, particularly in the context of FCA claims where the alleged falsity is premised on a lack of medical necessity in connection with the...more

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