The HHS Office of Inspector General (OIG), in connection with its enforcement responsibilities, must exclude a party from the federal health care programs if the party is found to have violated certain federal laws. This type...more
1/17/2025
/ Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
OIG ,
Settlement ,
TRICARE
In this issue we report on recent qui tam activity and look at three unsealed cases.
One case involves allegations of “up coding” by a hospital that allegedly billed routine transport as emergency transport, reimbursed at...more
Trends & Analysis -
..This issue looks at 18 health care–related qui tam cases that were unsealed in whole or in part in late October through November 2016.
..The cases identified were filed in federal district courts...more
Featured Unsealed Cases
United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) -
Complaint Filed: May 6, 2013 -
Complaint Unsealed: October 24, 2016...more
3/17/2017
/ Anti-Retaliation Provisions ,
Civil Penalty Fund ,
Co-Conspirators ,
Corporate Integrity Agreement ,
Criminal Penalties ,
Dismissals ,
False Billing ,
False Claims Act (FCA) ,
False-Certification of Conformance ,
Former Employee ,
Guilty Pleas ,
Home Health Care ,
Intervenors ,
Kickbacks ,
Medicaid ,
Medicare ,
Qui Tam ,
Relators ,
Stark Law ,
State False Claims Acts ,
Whistleblowers
Trends & Analysis -
We have identified 24 health care–related qui tam cases that have been unsealed since our last Qui Tam Update. Of the 24 cases, five were filed within the past year, seven were filed in 2014, three...more
Most health-care lawyers are accustomed to monitoring the high profile areas of regulatory enforcement in health care. However, many hospital lawyers, whether in-house or outside counsel, are unaware of the potential...more
10/23/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Certificates of Compliance ,
Civil Monetary Penalty ,
CLIA ,
Clinical Laboratory Testing ,
Department of Health and Human Services (HHS) ,
Diagnostic Tests ,
Food and Drug Administration (FDA) ,
Healthcare ,
Hospitals ,
Laboratories ,
Laboratory Developed Tests ,
Medicaid ,
Medicare ,
Sanctions
Trends & Analysis:
..We have identified 15 health care–related qui tam cases that were unsealed since our last Qui Tam Update. Of those, 12 were filed from 2012 to the present. All but two cases had been pending more...more
10/9/2015
/ Anti-Retaliation Provisions ,
Corporate Integrity Agreement ,
Declination ,
Department of Justice (DOJ) ,
Employees ,
False Claims Act (FCA) ,
Former Employee ,
Healthcare ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
Medicare ,
OIG ,
Overpayment ,
Qui Tam ,
Relators ,
Settlement ,
Social Security Act ,
Stark Law ,
State False Claims Acts ,
Whistleblowers
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