In today’s complex healthcare landscape, whistleblower claims are a major source of regulatory and legal risk for organizations. Last year saw a record number of “qui tam” claims filed under the False Claims Act. While...more
In a recent False Claims Act case, a long-term care pharmacy and consulting services provider was found liable for submitting false claims to the government, resulting in a jury verdict of over $135 million in damages. The...more
In January, the Department of Justice released its annual fraud statistics summarizing health care fraud settlements and judgments during the 2024 fiscal year. Last year, there were over $2.9 billion in fraud settlements and...more
2/27/2025
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Physician Payments ,
Physicians ,
Settlement ,
Stark Law ,
Whistleblowers
Providers are required by federal law to return Medicare and Medicaid overpayments within 60 days of identifying the overpayment or they can be liable under the False Claims Act. Since 2016, providers have relied on Centers...more
In September, the United States Department of Justice (DOJ) updated its corporate compliance program guidance which outlines criteria to look for in determining whether an organization’s compliance program is “adequate and...more
Providers will often pay physicians for serving in important administrative roles within the organization. Compensation for administrative services can create risk to the organization under multiple laws, including the...more
In the wake of the United States Supreme Court’s decision in U.S. ex rel. Schutte v. SuperValue, Inc., interpreting the False Claims Act’s scienter element – referring to the defendant’s knowledge and subjective beliefs –...more
We often work with valuation experts to ensure compensation payments between healthcare organizations and physicians are fair market value and commercially reasonable for purposes of compliance with the Stark Law and the...more
4/26/2024
/ Anti-Kickback Statute ,
Compliance ,
Fair Market Value ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Physicians ,
Settlement ,
Stark Law ,
Valuation ,
Whistleblowers ,
White Collar Crimes
Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more
3/4/2024
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Final Judgment ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Fraud ,
Qui Tam ,
Regulatory Violations ,
Settlement ,
Whistleblowers
Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more
The United States Department of Justice (DOJ) has filed another False Claims Act case against a long-term care provider premised on the quality of care provided to its residents. The DOJ is increasingly utilizing substandard...more