News & Analysis as of

False Claims Act (FCA) Skilled Nursing Facility Medicare

Baker Donelson

Looking Back at 2024: Key Health Care Regulatory Legal Developments in Fraud and Abuse, Compliance, and Enforcement

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The health care regulatory space realized significant regulatory and enforcement developments in 2024 that are influencing how providers and industry stakeholders approach various compliance measures and enforcement...more

ArentFox Schiff

Investigations Newsletter: Home Health Care Company to Pay $3 Million to Resolve FCA Allegations

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Home Health Care Company to Pay $3 Million to Resolve FCA Allegations - The US Department of Justice (DOJ) announced that Saad Enterprises Incorporated, operating as Saad Healthcare, agreed to pay $3 million to resolve...more

ArentFox Schiff

Investigations Newsletter: Massachusetts District Court Judge Applies Heightened Causation Standard in FCA Case

ArentFox Schiff on

Massachusetts District Court Judge Applies Heightened Causation Standard in FCA Case - On January 6, a District Court of Massachusetts judge granted summary judgment for defendants on allegations of violating the...more

Baker Donelson

Enhancing Compliance in Nursing Facilities: OIG's New Guidance

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The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) issued new Nursing Facility Industry Segment-Specific Compliance Program Guidance (Nursing Facility ICPG) for nursing facilities...more

Bricker Graydon LLP

A Long-Awaited Change: OIG Updates its Compliance Program Guidances

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From 1998-2008, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published compliance program guidelines for various industries in the Federal Register....more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | August 2022 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant enforcement activity between July 21 and August 20, 2022. Key updates include a case in which the US Court of Appeals for the Eighth Circuit...more

Health Care Compliance Association (HCCA)

[Virtual Event] Healthcare Enforcement Compliance Conference - November 7th - 9th, 8:55 am - 3:30 pm CST

Hear directly from the enforcement community - Want to gain insight into properly monitoring, detecting, investigating, and managing violations? Join us virtually at HCCA’s Annual Healthcare Enforcement Compliance...more

ArentFox Schiff

Investigations Newsletter: Jury Orders Eli Lilly To Pay $61 Million

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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

McDermott Will & Schulte

Healthcare Regulatory Check-up Newsletter | July 2022 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant activity between June 21 and July 20, 2022. During this period, the Supreme Court of the United States overturned Roe v. Wade, which historically...more

Harris Beach Murtha PLLC

Continued: Summary of Fraud and Abuse Enforcement Yields Insight for Health Care Compliance and Risk Assessment

The following is a summary of the federal Health and Human Services agency’s Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are based...more

Bricker Graydon LLP

Skilled nursing facility operator settles false claims case involving allegations that the company failed to report and return...

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On June 29, 2021, the Department of Justice (DOJ) announced a settlement with California skilled nursing facility operator Plum Healthcare Group LLC and facility Azalea Holdings LLC dba McKinley Park Care Center (Plum) to...more

Fox Rothschild LLP

The Importance Of Updating Compliance Programs For Skilled Nursing, Assisted Living And Other Residential Care Facilities

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Skilled Nursing Facilities in particular and to a lesser extent other types of Residential Care Facilities, including Assisted Living Facilities and Behavioral Health Facilities, have always been under the government’s...more

ArentFox Schiff

Investigations Newsletter: Nursing Home Chain Agrees to Pay $11.2 Million to Resolve False Claims Act Allegations

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On May 21, 2021, SavaSeniorCare LLC and several of its affiliates, which own and operate skilled nursing facilities across the country, agreed to pay $11.2 million to resolve claims that the companies billed Medicare for...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 8. News Briefs: March 2021

Report on Medicare Compliance 30, no. 8 (March 1, 2021) - According to a CMS spokesperson, “CMS has not yet determined when Targeted Probe and Educate reviews will resume.” Meanwhile, “CMS continues to temporarily pause...more

Bass, Berry & Sims PLC

Eleventh Circuit Reinstates Massive FCA Judgment in Ruckh

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The roller coaster ride of U.S. ex rel. Ruckh v. Genoa Healthcare, LLC continues. In a previous post, we wrote about the staggering $348 judgment entered following a jury verdict against a management company and skilled...more

ArentFox Schiff

Investigations Newsletter: Texas Man Charged for Allegedly Filing False PPP Loan Applications

ArentFox Schiff on

COVID Relief Program Fraud Charges - DOJ continues to announce charges against defendants accused of fraud in connection with allegedly false loan applications submitted under the Paycheck Protection Program (PPP)...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 7. News Briefs: February 2020 #4

Report on Medicare Compliance 29, no. 7 (February 24, 2020) -  Guardian Elder Care Holdings Inc., which operates more than 50 skilled nursing facilities (SNFs) in Pennsylvania, Ohio and West Virginia, and its related...more

Baker Donelson

DOJ Settlement Highlights False Claims Act Risk for Skilled Nursing Facilities

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The Department of Justice (DOJ) recently announced a $10 million settlement in a False Claims Act (FCA) qui tam lawsuit against Southern SNF Management, Inc. (Southern) and related skilled nursing facilities. The lawsuit...more

The Volkov Law Group

Rolling Along with False Claims Act Enforcement Actions (Part III of IV)

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Despite the controversial impact of the Supreme Court’s Escobar decision, the Justice Department’s False Claims Act prosecutions and settlements are continuing at a consistent rate – heading towards another multi-billion...more

Bricker Graydon LLP

Recent hospice settlements highlight where things can go wrong

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Two recent settlements highlight important Medicare hospice program requirements and the need to remain vigilant about compliance with Medicare program rules....more

Arnall Golden Gregory LLP

“Traps, Zaps, and Zingers:” District Court Overturns $350 Million False Claims Act Jury Verdict for Want of Materiality

On January 11, 2018, the United States District Court for the Middle District of Florida set aside a nearly $350 million False Claims Act (FCA) jury verdict rendered in February 2017 against a group of fifty-three skilled...more

Bass, Berry & Sims PLC

DOJ Bows Out of ManorCare FCA Case

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After years of investigation and litigation, and on the eve of a highly anticipated trial, the government abandoned its FCA case against ManorCare, the nation’s second-largest operator of skilled nursing homes and assisted...more

Holland & Knight LLP

Unreliable Expert Collapses DOJ-Led False Claims Act Case

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False Claims Act cases often turn into battles of the experts. But only rarely does that battle turn into a rout. It did last week in a case out of the Eastern District of Virginia, United States ex rel. Ribik v. HCR...more

Bass, Berry & Sims PLC

FCA Deeper Dive: Objective Falsity and Medical Necessity Cases

The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we will...more

King & Spalding

Florida Federal District Court Denies Government’s Attempt To Submit Statement of Interest In False Claims Act Case Where...

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On April 26, 2017, the United States District Court for the Middle District of Florida denied the government’s motion for leave to submit a “statement of interest” in a False Claims Act (FCA) action in which the government...more

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