The Office of Inspector General of the U.S. Department of the Health and Human Services (OIG) recently changed the language describing a compliance officer’s role in relation to other responsibilities he or she may have...more
When a company decides to self-disclose misconduct (or conduct that may be construed as such) to the government, that decision triggers a stream of additional questions. In the weighty deliberations about whether and what to...more
12/2/2021
/ Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Disclosure Requirements ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Legal Representatives ,
Liability ,
OIG ,
Self-Disclosure Requirements ,
Suppliers
Many health care providers treating senior patients rely on Medicare reimbursement and undertake significant measures to ensure proper billing and compliant practices. However, providers across the country may soon be subject...more
12/10/2020
/ American Medical Association ,
Centers for Medicare & Medicaid Services (CMS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Medicare ,
Petition for Review ,
PHRMA ,
Physician Medicare Reimbursements ,
Qui Tam ,
SCOTUS
On October 26, 2020, the Small Business Administration (SBA) published notice in the federal register that it is seeking approval from the government’s Office of Management and Budget (OMB) to release two new forms (Form 3509...more
11/13/2020
/ Business Interruption ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Liquidity ,
Loan Forgiveness ,
OMB ,
Paycheck Protection Program (PPP) ,
Questionnaires ,
SBA
The United States Court of Appeals for the Third Circuit ruled last week that whistleblower relators need not show “objective falsity” to prove their claims, and that a dispute among physician experts about a clinical...more
3/12/2020
/ False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Insurance Fraud ,
Life Sciences ,
Medicare ,
Objective Falsity ,
Physicians ,
Professional Liability ,
Qui Tam ,
Relators ,
Scienter ,
Triable Issue of Fact ,
Whistleblowers
Federal enforcers typically announce (formally as well as informally) work plans or focus areas for the upcoming year that can provide some guidance as to where providers might anticipate enforcement action and, where they...more
All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more
2/4/2020
/ Appeals ,
Evidence ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Jury Verdicts ,
Medical Experts ,
Medical Records ,
Medicare ,
Objective Falsity ,
Physicians ,
Summary Judgment ,
Terminal Illness Treatments ,
Trial Court Orders ,
Vacated
Although a whistleblowing employee typically cannot release fraud claims against her employer brought on behalf of the United States under the False Claims Act (FCA), courts have demonstrated a willingness to enforce properly...more
10/9/2019
/ Anti-Retaliation Provisions ,
False Claims Act (FCA) ,
Fraud ,
Health Care Providers ,
Qui Tam ,
Release of Claims ,
Retaliation ,
Severance Agreements ,
Waiver of Liability ,
Waivers ,
Whistleblower Protection Policies ,
Whistleblowers
Tuesday’s ruling by the United States Court of Appeals for the Eleventh Circuit in United States v. AseraCare is a win for hospice and other health care providers who have long argued that a mere difference of clinical...more
In a memo leaked last year (the Granston Memo), the U.S. Department of Justice (DOJ) instructed its prosecutors to more seriously consider dismissing meritless whistleblower False Claims Act (FCA) cases when it is in the...more
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
3/12/2018
/ Administrative Procedure Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
Enforcement Guidance ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Judgment on the Merits ,
Materiality ,
Medicare ,
Memorandum of Guidance ,
National Security ,
Public Comment ,
Qui Tam ,
Universal Health Services Inc v United States ex rel Escobar
As most recently spotlighted by the Department of Justice’s intervention in whistleblower claims against ManorCare, DOJ is increasing its enforcement of the False Claims Act (FCA) against therapy providers. In particular, DOJ...more