News & Analysis as of

Fraud › Billing

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
ArentFox Schiff

Navigating OIG’s Advisory Opinion on Medical Device Billing Arrangements and Anti-Kickback Statute Risks

ArentFox Schiff on

On July 1, the US Department of Health and Human Services’ Office of Inspector General (OIG) released Advisory Opinion No. 25-08, issuing an unfavorable determination regarding a proposed arrangement in which a medical device...more

Fox Rothschild LLP

(Apparent) Litigation by Ambush is Not a Good Tactic in the Business Court

Fox Rothschild LLP on

Prevailing at summary judgment is rare. Prevailing when there are competing motions on the same issue (fraud) is even rarer. In this opinion, Judge Davis granted the Defendants’ motion and denied the Plaintiff’s, ending the...more

Marshall Dennehey

Class Action Out of Minnesota with Potential Impacts on Litigating and Negotiating Major Case

Marshall Dennehey on

A class action suit is brewing in Minnesota which has the potential for major implications in the way major case investigations are litigated and negotiated. In Taqueria El Primo LLC et al. v. Illinois Farmers Ins. Co. et...more

Kerr Russell

Did I Commit Fraud?

Kerr Russell on

Question: I am under audit by a dental plan I participate with. The audit has identified a few issues in connection with how my billing employees have been submitting claims for payment. For example, the name of the treating...more

Morrison & Foerster LLP - Government...

Supreme Court To Consider The False Claims Act’s Intent Standard

Morrison & Foerster LLP - Government... on

On Friday, January 13, the Supreme Court agreed to consider whether the False Claims Act (“FCA”) covers compliance lapses tied to regulatory interpretations that are incorrect but “objectively reasonable.” The Supreme Court...more

McDermott Will & Emery

OIG Medicare Telehealth Data Brief Demonstrates Continued Focus on Data Analytics in Program Integrity Efforts

McDermott Will & Emery on

On September 2, 2022, the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a data brief analyzing telehealth services covered by Medicare and related program integrity risks. OIG...more

ArentFox Schiff

OIG Reports Indicate the Government's Interest in Balancing Ongoing Telehealth Access With Increased Oversight

ArentFox Schiff on

A pair of reports recently issued by the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) highlight the important role telehealth services have played in ensuring access to medical...more

Carlton Fields

Third Circuit Affirms District Court’s Denial Of Certification Of Nationwide Class Of Plaintiffs Alleging Consumer Fraud And...

Carlton Fields on

Plaintiffs alleged in their putative nationwide class action complaint that Quest Diagnostics was liable for consumer fraud, unjust enrichment, and violations of the Fair Debt Collections Practices Act for overbilling...more

Williams Mullen

Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For “Incident To” Services Means For Medicare Providers.

Williams Mullen on

In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider who relies...more

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