On 18 February 2025, the First Circuit Court of Appeals issued its decision in United States v. Regeneron Pharmaceuticals, Inc., determining that “but-for” causation is the proper standard for False Claims Act (FCA) actions...more
On 15 January 2025, the US Department of Justice (DOJ) published its report (Report) announcing civil recoveries under the False Claims Act (FCA) for Fiscal Year (FY) 2024. The recoveries for FY 2024 exceeded US$2.9 billion,...more
1/24/2025
/ Cybersecurity ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Medicare ,
Medicare Advantage ,
Opioid ,
Qui Tam ,
Settlement ,
Stark Law ,
Whistleblowers
On 22 February 2024, the US Department of Justice (DOJ) published the statistics for federal civil fraud recoveries in Fiscal Year (FY) 2023. The DOJ announced that the “government and whistleblowers were party to 543...more
6/25/2024
/ Anti-Kickback Statute ,
Compliance ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Internal Investigations ,
Kickbacks ,
Pharmaceutical Industry ,
Settlement ,
White Collar Crimes
On 22 February 2024, the US Department of Justice (DOJ) published its report (Report) announcing civil recoveries under the False Claims Act (FCA) for Fiscal Year (FY) 2023. The recoveries for FY 2023 exceeded US$2.68...more
3/4/2024
/ Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Incentives ,
Paycheck Protection Program (PPP) ,
Physicians ,
Qui Tam ,
Whistleblowers ,
White Collar Crimes
On 7 February 2023, the US Department of Justice (DOJ) publicly reported the statistics for federal civil fraud recoveries in Fiscal Year (FY) 2022. While the DOJ emphasized in its accompanying press release that “the...more
In a significant departure from the general downward trend in False Claims Act (FCA) civil fraud recoveries over the past half-decade —and as predicted last year —recoveries in Fiscal Year (FY) 2021 drastically increased...more
False Claims Act (FCA) civil fraud recoveries in Fiscal Year (FY) 2020 dropped over US$850 million when compared to those in FY 2019. While the more than US$2.2 billion in recoveries in FY 2020 continued a general downward...more
In 2019, the False Claims Act (“FCA”) remained the federal government’s (“Government”) primary method of civil fraud enforcement. While the more than $3 billion in civil fraud recoveries in Fiscal Year (“FY”) 2019 resulted...more
New frontiers are emerging in health care as burgeoning technologies merge with health care’s ever-evolving landscape. While these new frontiers provide seemingly endless possibilities and opportunities for improving the...more
In 2018, the False Claims Act (“FCA”) continued to be one of the federal government’s (“Government”) preferred civil fraud enforcement tools across a variety of industries. The healthcare industry, however, remained the...more
In Part 3 of our series on health care investigations, Mark Rush and John Lawrence discuss the process for external investigations conducted by federal and state governmental agencies, including in the context of qui tam...more
11/27/2018
/ Civil Investigation Demand ,
Dismissals ,
Employee Rights ,
False Claims Act (FCA) ,
Frivolous Lawsuits ,
Government Agencies ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Internal Investigations ,
Obstruction of Justice ,
Qui Tam ,
Search & Seizure ,
Search Warrant ,
Subpoenas ,
Whistleblowers
In Part 2 of our series on health care investigations, Mark Rush and John Lawrence continue the discussion on internal investigations. Specifically, the episode walks through how to conduct an internal investigation,...more
11/27/2018
/ Audits ,
Bias ,
Corrective Actions ,
Data Collection ,
Disclosure Requirements ,
Document Destruction ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Healthcare Workers ,
Internal Investigations ,
Interviews ,
Outside Counsel ,
Policies and Procedures ,
Reporting Requirements ,
Self-Disclosure Requirements ,
Upjohn Warnings
In this episode, Mark Rush and John Lawrence discuss the federal government’s expectations related to health care organizations conducting internal investigations and demonstrating a commitment to compliance. The episode also...more
10/30/2018
/ Anti-Kickback Statute ,
Civil Liability ,
Civil Monetary Penalty ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Internal Investigations ,
OIG ,
Qui Tam ,
Risk Mitigation ,
Stark Law
Recently, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced its largest ever national health care fraud takedown, resulting in charges against 601 diverse defendants including...more
7/19/2018
/ Anti-Fraud Provisions ,
Anti-Kickback Statute ,
Bribery ,
Corruption ,
Criminal Conspiracy ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Drug Distribution ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
FBI ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Medicare Fraud Strike Force ,
OIG ,
Opioid ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians ,
Prescription Drugs ,
State Attorneys General ,
TRICARE