News & Analysis as of

False Claims Act (FCA) Fraud Health Insurance

Goodwin

Aetna’s “Fraud Scheme” Lawsuit Against Radiology Group Highlights Health Plans’ Resistance to Private-Equity-Backed Providers

Goodwin on

On December 23, 2024, various Aetna affiliates (referred to hereafter as Aetna) filed suit against Radiology Partners, Inc., a national, private-equity-backed radiology group, alleging that Radiology Partners defrauded the...more

Health Care Compliance Association (HCCA)

Private-pay “crime stoppers”: Digesting the Corporate Whistleblower Awards Pilot Program

The U.S. Department of Justice’s (DOJ) Criminal Division launched its Corporate Whistleblower Awards Pilot Program (“Criminal Whistleblower Program”) in August of 2024 to encourage tips for various types of fraud, including...more

McAfee & Taft

Gavel to Gavel: Justice Department takes aim at private health plan fraud

McAfee & Taft on

Historically, the U.S. Department of Justice has directed its efforts on combatting healthcare fraud by focusing on persons and companies who defraud or attempt to defraud federally funded healthcare programs, such as...more

Health Care Compliance Association (HCCA)

Florida Web Designer Settles with DOJ on 2020 HealthyKids.org Medicaid Breach

A Florida communications firm and its owner agreed to pay $293,771 to resolve False Claims Act (FCA) allegations that they failed to secure personal information on a federally funded Florida children’s health insurance...more

Mintz - Health Care Viewpoints

OIG Expresses Concern about Laboratory Specimen Collection Payments to Hospitals in AO 22-09

Last week, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) issued Advisory Opinion No. 22-09 (AO 22-09), which addresses a proposed arrangement pursuant to which the operator of a...more

ArentFox Schiff

Investigations Newsletter: COVID-19 Task Force Established to Enhance Enforcement Efforts against Fraud

ArentFox Schiff on

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

Bass, Berry & Sims PLC

FCA Issues to Watch: Pharmaceutical and Device Developments | INSIDE THE FCA

Bass, Berry & Sims PLC on

The government’s FCA enforcement efforts have continued to focus on key areas concerning the pharmaceutical and medical device industries. In fact, drug and device manufacturers accounted for nearly half of the enforcement...more

The Volkov Law Group

Private Health Insurance Fraud — Billions And Billions

The Volkov Law Group on

When it comes to health insurance fraud, Carl Sagan’s obsession with the words – billions and billions — are particularly accurate. As the government’s role in health care increases, it is inevitable that fraud against...more

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