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
$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
Anticipated Landmark Supreme Court Decision May Be Anything But On -
April 18, 2023, the US Supreme Court heard oral arguments in a set of highly anticipated cases regarding the scienter—or knowledge—provision of the False...more
4/24/2023
/ Appeals ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Oral Argument ,
Penalties ,
Pharmacy Benefit Manager (PBM) ,
Restitution ,
SCOTUS
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
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
California Man Convicted in $27 Million PPP Fraud Scheme -
After a trial before a federal jury, a California man was convicted of bank fraud, making false statements to a financial institution, and money laundering for...more
4/1/2022
/ Bank Fraud ,
Criminal Convictions ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
False Statements ,
Financial Institutions ,
Fraud ,
Healthcare Fraud ,
IRS ,
Kickbacks ,
Medicare ,
Paycheck Protection Program (PPP)
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
A group of New Jersey home health care companies (collectively, the BAYADA Companies), have agreed to pay $17 million to resolve claims that they violated the False Claims Act and Anti-Kickback Statute.
Home Health Agency...more
According to court documents, the defendant admitted to, among other things, distributing unnecessary compound prescriptions by adjusting prescriptions and paying recruiters commissions for procuring prescriptions for...more
7/26/2021
/ Criminal Conspiracy ,
Cybersecurity ,
Drug Compounding ,
Foreign Corporations ,
Hackers ,
Healthcare Fraud ,
Kickbacks ,
Malware ,
SBA ,
Trade Secrets ,
TRICARE
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
Where’s the Beef? Two Charged with $650 Million Cattle Ponzi Scheme -
On May 12, the Department of Justice (DOJ) announced that a federal district court in Colorado unsealed an indictment alleging that two individuals ran...more
5/17/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Consumer Financial Products ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Financial Markets ,
Healthcare Fraud ,
Investment Fraud ,
Investment Funds ,
Mergers ,
Misrepresentation ,
Pharmaceutical Industry ,
Ponzi Scheme ,
Public Comment ,
Securities and Exchange Commission (SEC) ,
State and Local Government ,
Stock Prices
Pharmaceutical Company Agrees to Pay $12.6 Million to Settle FCA Allegations Involving Kickbacks -
On Tuesday, the Department of Justice announced a $12.6 million settlement with Incyte Corporation, a Delaware...more
5/10/2021
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Frivolous Lawsuits ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
Medicare ,
Money Laundering ,
Settlement ,
Telemarketing ,
TRICARE
Court Rules Prescription Drug Event and Enrollee Encounter Data Are 'Claims for Payment' Under the False Claims Act -
US District Judge Noel L. Hillman approved a whistleblower’s request to file a Fourth Amended Complaint...more
4/26/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
Fair Market Value ,
False Claims Act (FCA) ,
Healthcare Fraud ,
Kickbacks ,
Mail Fraud ,
Medicaid ,
Medicare Part A ,
Medicare Part D ,
Oil & Gas ,
Securities Fraud ,
Whistleblowers ,
Wire Fraud
Judge Rules Against Seizure of $330 Million Allegedly Connected to 1MDB Fraud Scheme -
On March 9, California District Court Judge Dale S. Fischer ruled that the government could not seize about $330 million in assets...more
3/22/2021
/ FinTech ,
Fraud ,
Healthcare Fraud ,
Identity Theft ,
Kickbacks ,
Mail Fraud ,
Malaysia ,
Medicaid ,
Medicare ,
Money Laundering ,
Saudi Arabia ,
Securities and Exchange Commission (SEC) ,
Wire Fraud
Pharmacy Owner and Accountant Indicted in $134m Health Care Fraud Scheme -
Mohamed Mokbel and Fathy Elsafty, of Houston, Texas, were arrested on charges of money laundering, health care fraud, and conspiracy to commit...more
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)
Supreme Court Declines to Review Issue of “Objective Falsity” Under False Claims Act -
On February 22, 2021, the United States Supreme Court denied petitions for certiorari in a case that could have addressed the issue of...more
3/1/2021
/ Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Health Care Providers ,
Healthcare Fraud ,
Hospice ,
Investment Fraud ,
Objective Falsity ,
Qui Tam ,
SCOTUS ,
Securities and Exchange Commission (SEC) ,
Whistleblowers
Despite Decrease in 2020 False Claims Act Recoveries, Investigations and Litigation Expected to Rise Under the Biden Administration -
As previously detailed by Arent Fox, total False Claims Act (FCA) recoveries for the...more
2/1/2021
/ Anti-Kickback Statute ,
Biden Administration ,
CARES Act ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Healthcare Fraud ,
Investigations ,
Kickbacks ,
Medicare ,
Paycheck Protection Program (PPP) ,
Recovery Plans ,
Settlement Agreements ,
TRICARE
Deutsche Bank to Pay Over $130 Million to Resolve Foreign Corrupt Practices Act and Fraud Allegations -
Deutsche Bank Aktiengesellschaft (Deutsche Bank) has agreed to pay more than $130 million to resolve the government’s...more
1/18/2021
/ Accounting Controls ,
BDC ,
Bribery ,
Bristol-Myers Squibb ,
Criminal Penalties ,
Deferred Prosecution Agreements ,
Deutsche Bank ,
Disgorgement ,
Drones ,
False Claims Act (FCA) ,
Financial Institutions ,
Foreign Corrupt Practices Act (FCPA) ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Money Laundering ,
Qui Tam ,
Sanofi-Aventis ,
SCOTUS ,
Securities and Exchange Commission (SEC) ,
Spoofing ,
Telemedicine ,
U.S. Navy ,
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
Russian National Sentenced to Prison for $100 Million Cyber Fraud Conspiracy -
On October 30, 2020, a Russian national was sentenced to eight years in prison for his role in a scheme to illicitly obtain and use sensitive...more
11/6/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Medicare ,
Physicians ,
Qui Tam ,
Russia ,
SCOTUS ,
Sensitive Personal Information ,
Whistleblowers
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