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Fraud › Fraud and Abuse › Medicare

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Sheppard Mullin Richter & Hampton LLP

Proving Fraud is and Should Be Hard: Lessons from a Recent Medicare Advantage False Claims Act Decision

Sheppard Mullin Richter & Hampton LLP on

The litigator’s adage “it’s easy to plead, it’s hard to prove” once again came true in the long-running False Claims Act (FCA) case targeting Medicare Advantage (“MA”) plans operated by UnitedHealth (United). Eight years...more

Rivkin Radler LLP

FCA Delivers: Government Recovered $2.9 Billion in 2024

Rivkin Radler LLP on

The U.S. Department of Justice (DOJ) recovered $2.9 billion under the False Claims Act (FCA) in 2024, a 5% bump from 2023. This total represents the most recovered since 2021 and reaffirms the FCA’s central role in the...more

Venable LLP

A Proposed New Regulatory Environment for Medicare Hospice Providers: Application of the 36-Month Rule, Increasing Enrollment...

Venable LLP on

On July 10, 2023, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that would (i) include hospices in the 36-month rule ownership transfer restrictions that currently exist for home...more

Dorsey & Whitney LLP

Healthcare Fraud Settlement Showcases Government’s Additional Focus on COVID-19-Related Fraud

Dorsey & Whitney LLP on

The Department of Justice (“DOJ”) last month announced a new blockbuster settlement agreement under the False Claims Act, 31 U.S.C. § 3729 et seq (“FCA”), involving alleged violations of the Stark law and other efforts to...more

Ruder Ware

ASLMS Annual Meeting Special Coverage: Legal and Compliance Issues Impacting Medical Practices Using Laser Technology

Ruder Ware on

Medical practices that routinely use laser technology are subject to some of the same legal issues as other types of practices. Use of lasers creates additional compliance issues and highlights certain compliance risk areas....more

Cooley LLP

Blog: OIG Issues Fraud Alert re: Physician Compensation Arrangements

Cooley LLP on

The U.S. Health and Human Services Office of Inspector General (OIG) released a Fraud Alert today titled Physician Compensation Arrangements May Result in Significant Liability. The OIG directs health care professionals...more

Baker Donelson

Medicare Enrollment Moratoria: Implications for Service Expansion and Certain Transactions

Baker Donelson on

One of the provisions of the Affordable Care Act provided CMS with the authority to impose a temporary enrollment moratorium for a particular type of provider or supplier if determined to be necessary to combat fraud and...more

Mintz - Health Care Viewpoints

Report Highlights Record-Breaking Year of Enforcement for HHS and DOJ

Mintz - Health Care Viewpoints on

Yesterday, the Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) released their Annual Report for the Health Care Fraud and Abuse Control Program (the “Program”). The report highlights the...more

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