News & Analysis as of

Fraud Compliance Healthcare Fraud

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Hendershot Cowart P.C.

Qlarant, Novitas Audits Escalate as Medicare Skin Substitutes Spending Hits $1.6 Billion, CMS Seeks Evidence of Clinical...

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The wound care industry faces unprecedented scrutiny as Medicare Part B expenditures for skin substitutes exceeded $1.6 billion in the fourth quarter of 2023 alone. The spending surge has triggered a wave of skin substitute...more

Cozen O'Connor

Texas AG Settles for $40 Million Over Medicaid Fraud Allegations

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Texas AG Ken Paxon announced a settlement with Molina Healthcare of Texas, Inc. and Molina Healthcare, Inc. (collectively, “Molina”), to resolve allegations of Medicaid fraud. The AG’s office claims Molina violated the Texas...more

DLA Piper

False Claims Act Year in Review: 2024

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The US government and private plaintiffs use the False Claims Act (FCA) – a federal statute originally enacted in 1863 in response to defense contractor fraud during the American Civil War – to combat various forms of fraud...more

Rivkin Radler LLP

Provider and Beneficiaries Conspired to Defraud Louisiana’s Medicaid Program

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Healthcare fraud is prevalent within state Medicaid programs due to the massive amounts of money flowing through the system. In Louisiana, the Estate of Yolanda Burnom and her former company, Community Healthcare Solutions,...more

McCarter & English Blog: Government Contracts...

Whisper Through the Screams: DOJ Commits to False Claims Act Enforcement in 2025

Amid the chaos of the past few weeks—sweeping executive orders, relentless cost-cutting, and an air of uncertainty that lingers like smoke after a fire—federal contractors have been left reeling, straining to hear what comes...more

Lowenstein Sandler LLP

Trump Administration Plans Aggressive FCA Enforcement

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At the Federal Bar Association’s annual qui tam conference in Washington, D.C. on Feb. 20, 2025, the Deputy Assistant Attorney General for the Department of Justice’s (DOJ) Commercial Litigation Branch, Michael Granston, said...more

Bass, Berry & Sims PLC

Fourth Circuit Holds that Violation of CIA Can Support Reverse False Claims and Adopts Relaxed Rule 9(b) Presentment Requirement

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On February 3, the U.S. Court of Appeals for the Fourth Circuit reversed a district court’s grant of a motion to dismiss, holding in relevant part that: - Violations of a Corporate Integrity Agreement (CIA) can create an...more

ArentFox Schiff

Investigations Newsletter: President Trump Puts a “Pause” on FCPA Enforcement

ArentFox Schiff on

President Trump Puts a “Pause” on FCPA Enforcement - On Monday, President Donald Trump signed an executive order (EO) pausing the enforcement of the Foreign Corrupt Practices Act (FCPA). According to the EO, the pause will...more

Rivkin Radler LLP

NYS OMIG Publishes 2025 Work Plan

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On January 29, the New York State Office of the Medicaid Inspector General (OMIG) published its 2025 Work Plan, which provides a preview of the OMIG’s program integrity initiatives for the upcoming year. While this post...more

Morrison & Foerster LLP

China Issues First Compliance Guidelines to Combat Commercial Bribery Risks - UPDATED February 2025

On January 10, 2025, China’s State Administration for Market Regulation (“SAMR”) put into effect its Compliance Guidelines for Healthcare Companies to Prevent Commercial Bribery Risks (“Compliance Guidelines”)....more

Bradley Arant Boult Cummings LLP

The False Claims Act in 2024: A Year in Review

In 2024, the government and whistleblowers were party to 558 False Claims Act (FCA) settlements and judgments, just slightly fewer cases than last year’s record. As a result, collections under the FCA exceeded $2.9 billion,...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

Lowenstein Sandler LLP

Virginia Hospital Indicted for Allegedly Turning a Blind Eye to Doctor’s Crimes

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In an unusual criminal prosecution, the Chesapeake Regional Medical Center (CRMC), a hospital in Chesapeake, Virginia, was indicted last week by a federal grand jury in Virginia for conspiring to defraud the United States and...more

Fox Rothschild LLP

FCA Whistleblower Complaints Reach All Time High in 2024

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The U.S. Department of Justice (DOJ) published its 2024 False Claims Act (FCA) statistics and press release this week touting $2.9 billion in judgments and settlements last fiscal year, slightly higher than 2023’s $2.7...more

Bass, Berry & Sims PLC

Athira Pharma Inc. Agrees to Settle False Claims Act Allegations

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On January 6, the Department of Justice (DOJ) announced that Athira Pharma Inc., a Washington-based biopharmaceutical company, agreed to pay over $4 million to settle allegations it violated the False Claims Act (FCA). The...more

Husch Blackwell LLP

Forget the False Claims Act—How a Virginia Hospital Got Criminally Charged

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On January 8, 2025, a federal grand jury in Virginia returned an indictment against a hospital. This rare criminal event in healthcare alleges that Chesapeake Regional Medical Center conspired to defraud the United States and...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

Second Circuit Expands Anti-Kickback Statute Liability: “At Least One Purpose” is Enough

In a significant ruling, the Second Circuit Court of Appeals recently expanded the scope of the Anti-Kickback Statute (AKS).The Court joined other circuit courts across the country in adopting, for the first time, the...more

McAfee & Taft

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

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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

Holland & Hart LLP

Key Compliance Takeaways for Companies from the DOJ's New Corporate Whistleblower Program

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On August 1, 2024, the U.S. Department of Justice (“DOJ”) announced its new “Corporate Whistleblower Awards Pilot Program” (“DOJ Program”), a three-year initiative managed by DOJ’s Money Laundering and Asset Recovery Section....more

Harris Beach Murtha PLLC

False Claims Act Enforcement Highlights Need for Robust Compliance Programs

The U.S. Department of Justice (“DOJ”) announced its False Claims Act (“FCA”) enforcement statistics for FY 2023 and identified key priorities for FCA enforcement in 2024 and beyond. The DOJ continues to pursue FCA...more

Womble Bond Dickinson

Current Trends and Real-World Best Practices in Healthcare Fraud Compliance

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Recently, Womble Bond Dickinson held its First Annual Health Care Fraud Symposium, a webinar designed to discuss critical healthcare fraud topics. WBD Partner Joe Whitley moderated a discussion with WBD attorneys Luke Cass,...more

Morgan Lewis

DOJ Ramping Up Fraud Enforcement Efforts: 2021 Year in Review Report

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The US Department of Justice’s Criminal Division Fraud Section released its annual Year in Review report on February 15, covering 2021. Despite ongoing aftershocks associated with the global pandemic, this year’s report...more

BakerHostetler

Biden's New HHS Secretary Promises "Robust Enforcement"

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Introduction - On March 18, 2021, the Senate narrowly confirmed Xavier Becerra, the former attorney general of California, as U.S. Department of Health and Human Services (“HHS”) Secretary....more

King & Spalding

What’s in Store for White-Collar Enforcement in 2021 and Beyond

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Federal white-collar prosecutions declined considerably from 2010 to 2019, and likely fell even further last year after courts and government offices closed. But given the impending end of the pandemic, another surge of...more

WilmerHale

The Role of Compliance in Government Enforcement

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As recent developments in corporate enforcement indicate, the United States Department of Justice (DOJ) continues to emphasize transparency, cooperation, and the importance of a strong compliance program. Enforcement trends...more

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