Former Healthcare Executives Convicted for Health Insurance Policy Fraud Scheme -
Steven Dorfman, the former chief executive officer and owner of the Florida-based healthcare company Simple Health, and John Sand, a former...more
2/19/2024
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Criminal Conspiracy ,
False Billing ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Insurance Fraud ,
Mail Fraud ,
Medical Equipment ,
Medicare ,
Paycheck Protection Program (PPP) ,
Scams ,
Sentencing ,
TRICARE ,
Wire Fraud
Three Individuals Sentenced for $3.5 Million COVID-19 Relief Fraud Scheme-
On February 6, three individuals were sentenced for fraudulently obtaining and misusing Paycheck Protection Program (PPP) loans that the US Small...more
Co-Founder of Fraudulent Cryptocurrency Sentenced to 20 Years in Prison -
Karl Sebastian Greenwood, a citizen of Sweden and the United Kingdom and co-founder of the cryptocurrency OneCoin, was sentenced to 20 years in...more
9/18/2023
/ Blockchain ,
Coronavirus/COVID-19 ,
Cryptocurrency ,
Department of Justice (DOJ) ,
Embezzlement ,
Fraud ,
Identity Theft ,
Misrepresentation ,
MLM Industry ,
Nonprofits ,
Sentencing
$140 Million Healthcare Fraud Case to Be Retried -
On June 27, a Houston federal district court judge indicated that a $140 million healthcare fraud case, which ended in mistrial in December 2022 due to allegations of...more
Top Reasons for 2022’s Downward Trend in False Claims Act Recoveries -
Following the US Department of Justice’s (DOJ) release of statistics regarding FCA settlements and judgments for the 2022 fiscal year, Law360 spoke...more
2/20/2023
/ CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fees ,
Fraud and Abuse ,
Healthcare ,
Kickbacks ,
Medicare Advantage ,
Opioid ,
Private Equity ,
Proposed Amendments ,
Qui Tam ,
Settlement ,
Stark Law ,
Telehealth ,
Whistleblowers
Pharmacy Owners Plead Guilty to COVID Fraud and Money Laundering Scheme -
Two New York men pled guilty for their alleged involvement in a complex money laundering conspiracy to launder proceeds from a fraudulent health...more
OIG Warns That Proposed Drug Discounts May Warrant Sanctions -
On October 5, the US Department of Health and Human Services’ Office of Inspector General (OIG) issued an advisory opinion assessing a proposal that involved...more
10/10/2022
/ Anti-Competitive ,
Anti-Kickback Statute ,
Bid Rigging ,
Bribery ,
Caltrans ,
Contractors ,
Coronavirus/COVID-19 ,
Criminal Convictions ,
Discounts ,
Drug Pricing ,
Economic Injury Disaster Loans ,
False Statements ,
Fraud and Abuse ,
Healthcare Fraud ,
IRS ,
Medicare ,
Medicare Part D ,
OIG ,
Sanctions ,
Tyson Foods ,
Wire Fraud
COVID-19 Fraud Update: DOJ Prosecutes More than 150 Defendants, 95 Criminal Cases -
Since the inception of the CARES Act, DOJ’s Fraud Section has prosecuted over 150 defendants in over 95 criminal cases. The Fraud Section...more
9/30/2022
/ CARES Act ,
Coronavirus/COVID-19 ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Economic Injury Disaster Loans ,
False Claims Act (FCA) ,
False Statements ,
Fraud ,
Genetic Testing ,
IRS ,
Kickbacks ,
Medicaid ,
Medicare ,
Paycheck Protection Program (PPP) ,
Payroll Expenses
Khadijah Chapman of Georgia, Daniel Labrum of Utah, and Eric O’Neil of Connecticut were all charged in separate indictments with submitting fraudulent Paycheck Protection Program (PPP) loan applications. According to the DOJ,...more
8/15/2022
/ Anti-Money Laundering ,
Bank Fraud ,
Bank Secrecy Act ,
BSA/AML ,
Coronavirus/COVID-19 ,
Criminal Conspiracy ,
Criminal Convictions ,
Crypto Exchanges ,
Department of Justice (DOJ) ,
Healthcare Fraud ,
Indictments ,
Paycheck Protection Program (PPP) ,
Wire Fraud
Jury Orders Eli Lilly To Pay $61 Million -
A federal jury in Illinois found that, beginning around 2004, drug manufacturer Eli Lilly deliberately underpaid rebates to Medicare programs by excluding retroactive drug prices...more
8/8/2022
/ Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Falsified Documents ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
Medicare ,
Medicare Fraud ,
Paycheck Protection Program (PPP) ,
Rebates ,
SBA ,
Skilled Nursing Facility ,
Wire Fraud
The DOJ announced charges against 21 people across nine federal districts for their alleged role in pandemic-related fraud schemes resulting in over $149 million in false billings to federal programs. This is the largest...more
4/22/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Deferred Prosecution Agreements ,
Department of Justice (DOJ) ,
False Billing ,
Foreign Corrupt Practices Act (FCPA) ,
Fraud ,
Medicare ,
Moderna Inc. ,
Political Candidates ,
Political Contributions ,
Securities Fraud ,
Vaccinations ,
Virus Testing ,
Wire Fraud
DOJ Attorneys Comment on the Rise of Telehealth Fraud During the COVID-19 Pandemic -
During the 2022 Qui Tam Conference of the Federal Bar Association, DOJ attorneys commented on the dramatic rise in the use of remote...more
2/28/2022
/ Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Foreign Corrupt Practices Act (FCPA) ,
Fraud ,
GAAP ,
Healthcare Fraud ,
IRS ,
Medicare ,
Non-GAAP Financial Measures ,
Qui Tam ,
Securities and Exchange Commission (SEC) ,
Telehealth
On October 26, Marcus Frazier of New York pled guilty to two counts of wire fraud affecting a financial institution for his alleged role in a scheme to obtain $6.9 million in Paycheck Protection Program (“PPP”) funds designed...more
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
COVID-19 Task Force Established to Enhance Enforcement Efforts against Fraud -
On May 17, 2021, the Department of Justice and U.S. Attorney General announced the establishment of the COVID-19 Fraud Enforcement Task Force,...more
5/24/2021
/ Attorney General ,
Centers for Disease Control and Prevention (CDC) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Department of Labor (DOL) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Falsified Documents ,
Fraud ,
Health Insurance ,
Healthcare Fraud ,
Medicaid ,
OIG ,
Paycheck Protection Program (PPP) ,
SBA ,
Vaccinations ,
Wire Fraud
DOJ Updates Actions to Combat Fraud Related to COVID-19 -
On March 26, 2021, the Department of Justice provided an update on its criminal and civil enforcement efforts to combat fraud related to the COVID-19 pandemic....more
Senior DOJ Official Michael Granston Discusses COVID Relief Enforcement, Granston Memo, and other FCA Issues -
Michael Granston, the Deputy Assistant Attorney General of the DOJ Civil Division, sat down this week with Jody...more
3/29/2021
/ Conflicts of Interest ,
Consumer Protection Laws ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraudulent Procurement ,
Kickbacks ,
Manufacturers ,
Medical Devices ,
OIG ,
Private Equity Funds ,
Relief Measures ,
The Granston Memo ,
Turkey ,
USAID
Individual Prosecutions Down But Corporate Resolutions Steady for DOJ’s Fraud Section in 2020, with More in the Pipeline -
The Department of Justice’s (“DOJ”) Fraud Section recently released a year-in-review report that...more
3/8/2021
/ Bribery ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Deferred Prosecution Agreements ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Executive Orders ,
False Claims Act (FCA) ,
Final Rules ,
Foreign Corrupt Practices Act (FCPA) ,
Fraud ,
Healthcare Fraud ,
Opioid ,
Paycheck Protection Program (PPP)
DOJ’s 2020 False Claims Act Recoveries Lowest Since 2008 -
On January 14, 2021, the Department of Justice (DOJ) announced that it obtained more than $2.2 billion in settlements and judgments from civil cases involving...more
1/25/2021
/ Bribery ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Federal Food Drug and Cosmetic Act (FFDCA) ,
Food and Drug Administration (FDA) ,
Fraud ,
IRS ,
Kickbacks ,
Medicaid ,
Medical Devices ,
Paycheck Protection Program (PPP) ,
Qui Tam ,
Relief Measures ,
SBA ,
Settlement ,
Whistleblowers ,
Wire Fraud
New York Pharmacy Owners Charged in $30 Million COVID-19 Health Care Fraud and Money Laundering Case -
On December 21, 2020, the Department of Justice (DOJ) announced that two owners of over a dozen New York-area...more
1/11/2021
/ California ,
Coronavirus/COVID-19 ,
Criminal Convictions ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Genetic Testing ,
Healthcare Fraud ,
Identity Theft ,
Medicare ,
Money Laundering ,
New York ,
Pharmacies ,
Pharmacist ,
State Attorneys General ,
Tennessee ,
Wire Fraud
HHS Announces Formation of FCA Working Group -
On December 4, 2020, the US Department of Health and Human Services (HHS) announced that it is creating a False Claims Act Working Group to enhance the partnership between...more
12/14/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Integrity Policies ,
Medicare ,
OIG ,
Proposed Rules ,
SCOTUS ,
Settlement Agreements ,
Stark Law ,
Value-Based Care ,
Working Groups
HHS Announces Final Rules Amending Stark Law Regulations and Anti-Kickback Statute -
On November 20, 2020, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services (HHS) published...more
12/7/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Criminal Conspiracy ,
DEA ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Federal Food Drug and Cosmetic Act (FFDCA) ,
Final Rules ,
Fraud ,
Health Care Providers ,
Inflated Projections ,
Medicaid ,
Medicare ,
Opioid ,
Physician Medicare Reimbursements ,
Purdue Pharma ,
Securities Fraud ,
Stark Law ,
Value-Based Care
Seven Individuals Charged in $16 Million COVID-Relief Fraud Scheme -
In an indictment unsealed on November 17, seven individuals were charged with conspiracy to commit wire fraud and wire fraud for allegedly submitting at...more
Investment Bank Fined $400 Million For Failing to Remediate Deficiencies in its Risk Management Systems -
On October 7, the Federal Reserve Board and Office of the Comptroller of the Currency issued a consent order...more
10/9/2020
/ Bank Fraud ,
CARES Act ,
Citigroup ,
Consent Order ,
Coronavirus/COVID-19 ,
Criminal Conspiracy ,
Durable Medical Equipment ,
False Statements ,
Federal Reserve ,
Fraud ,
Investment Banks ,
Kickbacks ,
Loan Applications ,
Mail Fraud ,
Medicare Fraud ,
Patient Privacy Rights ,
Paycheck Protection Program (PPP) ,
Pennsylvania ,
Remediation ,
Risk Management ,
Wire Fraud
DOJ Announces Charges Against 345 Defendants in Historic Nationwide Health Care Fraud and Opioid Takedown -
The DOJ announced a nationwide enforcement action charging 345 defendants across 51 federal districts with...more
10/5/2020
/ Anti-Dumping Agreement ,
Bribery ,
Coronavirus/COVID-19 ,
Countervailing Duties ,
Department of Justice (DOJ) ,
Economic Injury Disaster Loans ,
False Claims Act (FCA) ,
Healthcare Fraud ,
Kickbacks ,
Loan Applications ,
Medicare ,
Nonprofits ,
Opioid ,
Pharmacies ,
Physicians ,
SBA ,
Settlement ,
Substance Abuse ,
Telecommunications ,
Telemedicine ,
Wire Fraud