A couple of recent large-scale enforcement actions suggest that the U.S. Department of Justice (DOJ) may be placing increased emphasis on targeting black market prescription drug diversion. This is when pharmaceutical...more
3/5/2025
/ DEA ,
Department of Justice (DOJ) ,
Distributors ,
Enforcement Actions ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Pharmaceutical Industry ,
Pharmacies ,
Prescription Drugs ,
White Collar Crimes
One avenue for whistleblowers to take to report fraud against the government is to file a qui tam lawsuit under the federal False Claims Act. These lawsuits are complex because they have not two, but three parties to them –...more
7/24/2024
/ Anti-Retaliation Provisions ,
Defense Strategies ,
False Claims Act (FCA) ,
Federal Funding ,
Federal Grants ,
Fraud ,
Government Investigations ,
Healthcare Fraud ,
Law Enforcement ,
Paycheck Protection Program (PPP) ,
Qui Tam ,
Whistleblower Awards ,
Whistleblower Protection Policies ,
Whistleblowers ,
White Collar Crimes
The healthcare industry relies heavily on whistleblowers to bring fraudulent conduct and other forms of waste and abuse to the attention of regulators, law enforcement, and the public in general. If you have found signs of...more
6/25/2024
/ Anti-Retaliation Provisions ,
Defense Strategies ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Retaliation ,
Whistleblower Awards ,
Whistleblower Protection Policies ,
Whistleblowers ,
White Collar Crimes ,
Wrongful Termination
According to the National Health Care Anti-Fraud Association, an estimated $100 billion is lost to Medicare fraud every single year in the U.S., with overtaxed law enforcement agencies relying heavily on whistleblowers to...more
As a doctor or other licensed medical professional, the prospect of losing your license to practice medicine can be overwhelming. But, to protect your license—and your career—to the fullest extent possible, you need to act...more
3/21/2023
/ Defense Strategies ,
Health Care Providers ,
Healthcare Fraud ,
Investigations ,
Licensing Boards ,
Medical License ,
Medical Malpractice ,
Physicians ,
Professional Disciplinary Actions ,
Professional Liability Insurance ,
Professional Responsibility ,
State Medical Board
Similar to other types of healthcare entities, clinical laboratories have been facing enhanced scrutiny from federal authorities over the past couple of years. While this is due in part to fraud concerns related to COVID-19...more
3/8/2023
/ Anti-Kickback Statute ,
Civil Liability ,
Clinical Laboratories ,
Clinical Laboratory Testing ,
Coronavirus/COVID-19 ,
Criminal Liability ,
Defense Strategies ,
Department of Justice (DOJ) ,
Evidence ,
False Billing ,
FBI ,
Health Care Providers ,
Healthcare Fraud ,
Internal Audit Functions ,
Investigations ,
Risk Assessment
As a licensed physician in Texas, facing a Texas Medical Board (TMB) investigation can present significant risks. Depending on the allegations underlying the investigation, your medical license could be in jeopardy—and you...more
The U.S. Department of Justice’s (DOJ) Consumer Protection Branch works with other branches and federal law enforcement agencies to investigate and prosecute civil and criminal violations of the nation’s consumer protection...more
10/6/2022
/ Consumer Fraud ,
Consumer Protection Laws ,
Criminal Conspiracy ,
Criminal Investigations ,
Criminal Prosecution ,
Defense Strategies ,
Deferred Prosecution Agreements ,
Department of Justice (DOJ) ,
Elder Abuse ,
Enforcement Actions ,
Federal Trade Commission (FTC) ,
Food and Drug Administration (FDA) ,
FTC Act ,
Guilty Pleas ,
Healthcare Fraud ,
Mail Fraud ,
Wire Fraud
Facing a Qlarant audit is a serious matter for healthcare providers and other entities that bill Medicare or Medicaid. While the Qlarant Foundation is a non-profit entity, Qlarant Integrity Solutions is a profit-driven entity...more
Medical professionals, patients, and others can commit healthcare fraud by deceiving the healthcare system, such as providing medically unnecessary services, in order to get unauthorized benefits or payments. Facing...more
Yesterday, the U.S. Department of Justice (DOJ) announced that it has filed charges against 36 defendants in relation to an alleged health care fraud scheme that resulted in approximately $1.2 billion in fraudulent payments....more
7/21/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Enforcement Actions ,
FBI ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Medicare Beneficiaries ,
Physician Medicare Reimbursements ,
Physicians ,
Telehealth ,
Telemarketing ,
Telemedicine
Nearly all healthcare providers will face an audit (if not multiple audits) during their careers. Federal agencies such as the U.S. Department of Health and Human Services (HHS) routinely audit healthcare providers for...more
The Centers for Medicare and Medicaid Services (CMS) and its audit contractors have recently increased their use of Targeted Probe and Educate (TPE) audits to target providers suspected of improperly billing Medicare. While...more
6/21/2022
/ Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Criminal Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Medical Billing Codes ,
Medical Records ,
Medicare ,
Medicare Administrative Contractors (MAC) ,
Medicare Appeals ,
Medicare Fraud ,
Penalties ,
Physicians ,
Targeted Probe and Education (TPE) audit
Over recent years, the federal government has shown an increased interest in bringing healthcare fraud prosecutions. In fact, in 2020 alone, the federal government opened 1,148 new criminal healthcare fraud investigations,...more
Clinical laboratories have come under increased scrutiny in the past few years, especially those that deal with COVID-19 testing or drug testing.
These federal investigations can be surprising and confusing for lab...more
4/5/2022
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Liability ,
CLIA ,
Clinical Laboratories ,
Criminal Liability ,
Defense Strategies ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
FBI ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Healthcare Fraud ,
Investigations ,
OIG ,
Penalties ,
Physicians ,
Stark Law
The COVID-19 pandemic increased the business opportunities available to clinical labs, including molecular and respiratory labs. As the nation—and the world—struggled to develop adequate testing infrastructure, the federal...more
1/19/2022
/ Audits ,
Clinical Laboratories ,
Coronavirus/COVID-19 ,
Defense Strategies ,
Department of Health and Human Services (HHS) ,
FBI ,
Health Care Providers ,
Healthcare Fraud ,
Investigations ,
Medical Billing Codes ,
Medical Necessity ,
OIG ,
Patient Referrals ,
Physicians
The federal government has recently made clear its intention to go after healthcare providers who provide amniotic injections to certain Medicare and Medicaid recipients. Over recent years, the federal government has...more
10/26/2021
/ Anti-Kickback Statute ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Investigation Demand ,
Civil Liability ,
Criminal Liability ,
Defense Strategies ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
False Claims Act (FCA) ,
Government Investigations ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Physicians ,
Stark Law
The Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Justice (DOJ) are scrutinizing health care providers’ Medicare billings for amniotic injections. These injections are only eligible for Medicare...more
8/17/2021
/ Anti-Kickback Statute ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Investigation Demand ,
Department of Justice (DOJ) ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Medicare ,
Medicare Fraud
Durable medical equipment (DME) is particularly important for many Medicare beneficiaries. However, companies that manufacture and sell DME need to be careful because there are strict federal regulations outlining almost...more
7/28/2021
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Chief Compliance Officers ,
Civil Liability ,
Compliance ,
Compliance Commitees ,
Corrective Action Plans (CAPs) ,
Criminal Liability ,
Department of Health and Human Services (HHS) ,
Disciplinary Proceedings ,
Durable Medical Equipment ,
Employee Training ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
OIG ,
Physicians ,
Policies and Procedures ,
Standard of Conduct ,
TRICARE
Clinical laboratories such as respiratory and clinical labs that bill Medicare, Department of Health and Human Services (“DHHS”) programs, and other federal programs are subject to oversight by the Office of Inspector General...more
7/14/2021
/ Chief Compliance Officers ,
Clinical Laboratories ,
Compliance ,
Compliance Commitees ,
Coronavirus/COVID-19 ,
Criminal Prosecution ,
Defense Strategies ,
Department of Justice (DOJ) ,
False Billing ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Indictments ,
Investigations ,
OIG ,
Policies and Procedures ,
Virus Testing
The U.S. Department of Justice (DOJ) is cracking down on healthcare fraud, and many providers are finding themselves facing serious allegations. This includes criminal allegations in many cases. If these allegations lead to a...more
6/8/2021
/ Arraignment ,
Criminal Prosecution ,
Defense Strategies ,
Department of Justice (DOJ) ,
Discovery ,
Evidence ,
Federal Prosecutors ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
Indictments ,
Motion to Dismiss ,
Physicians ,
Plea Negotiations ,
Pre-Trial Motions ,
Preliminary Hearings
Zone Program Integrity Contractors (ZPICs) and Unified Program Integrity Contractors (UPICs) are federal contractors who work under the direction of the Centers for Medicare and Medicaid Services (CMS) to uncover fraudulent...more
5/25/2021
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Defense Strategies ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Billing ,
Health Care Providers ,
Healthcare Fraud ,
Medicare ,
Overpayment ,
Provider Payments ,
Underpayment ,
Zone Program Integrity Contractors (ZPICs)
As federal agencies and law enforcement investigate pharmacies around the country for health care fraud and kickback schemes, pharmacies should be proactive in understanding their regulatory environment and the importance of...more
5/11/2021
/ Civil Liability ,
Compliance ,
Criminal Liability ,
Government Investigations ,
Healthcare Fraud ,
Kickbacks ,
Pharmaceutical Industry ,
Pharmacies ,
Policies and Procedures ,
Prescription Drugs ,
Regulatory Requirements
It is tax season once again. While the Internal Revenue Service (IRS) has extended this year’s filing deadline to May 17, 2021 for individuals, businesses must still file by April 15, and all U.S. taxpayers must ensure that...more
4/13/2021
/ Cannabis-Related Businesses (CRBs) ,
Conservation Easements ,
Coronavirus/COVID-19 ,
Corporate Fraud ,
Criminal Investigations ,
Criminal Prosecution ,
Cryptocurrency ,
Enforcement Priorities ,
Federal Taxes ,
Filing Deadlines ,
Foreign Financial Assets ,
Gambling ,
Healthcare Fraud ,
Income Taxes ,
Independent Contractors ,
Internal Revenue Code (IRC) ,
IRS ,
Marijuana Related Businesses ,
Offshore Funds ,
Paycheck Protection Program (PPP) ,
Self Employed ,
Small Business ,
Tax Audits ,
Tax Deductions ,
Tax Evasion ,
Tax Fraud ,
Tax Liability ,
Tax Planning ,
Tax Refunds ,
Tax Relief ,
Tax Returns ,
Underpayment ,
Virtual Currency
Medicare pays billions of dollars in fraudulently billed claims each year. To recoup as many fraudulent reimbursements as possible, the Centers for Medicare and Medicaid Services (CMS) relies on various enforcement...more
4/6/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Defense Strategies ,
Documentation ,
False Billing ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
MACs ,
Medicare ,
Physicians ,
Recovery Audit Contractors (RACs)