News & Analysis as of

Fraud Medicaid Office of the Inspector General

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

DOJ and HHS Announce FCA Working Group

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On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced the formation of the DOJ-HHS False Claims Act Working Group to strengthen “their ongoing collaboration to advance...more

Epstein Becker & Green

HHS OIG Continues to Highlight How Medicaid Fraud Control Units Recovered $1.4 Billion in FY 2024

On June 25, 2025, the Office of the Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) released a short video containing the highlights of the Medicaid Fraud Control Units (“MFCUs”) Annual...more

Epstein Becker & Green

Medicaid Fraud Recoveries Top More Than $1 Billion in 2024—But Will the Big Beautiful Bill Impact Those Numbers in 2025?

On June 25, 2025, the Office of the Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) released a short video containing the highlights of the Medicaid Fraud Control Units (“MFCUs”) Annual...more

Foley & Lardner LLP

Key Takeaways: 7th Annual “Let’s Talk Compliance” Conference

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Editor’s Note: PYA and Foley & Lardner hosted the 7th Annual “Let’s Talk Compliance” two-day virtual conference on January 23 and 24, 2025. Panelists included Foley attorneys and PYA subject matter experts. The event was...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

Mintz - Health Care Viewpoints

EnforceMintz — Telemedicine Enforcement: Trends in 2024 Suggest More Sophisticated Enforcement to Come in 2025

The Department of Justice (DOJ) and the Office of the Inspector General for the Department of Health and Human Services (OIG) have historically focused their virtual health care enforcement efforts on “traditional”...more

Mintz - Health Care Viewpoints

EnforceMintz — Long Tail of Pandemic Fraud Schemes Will Likely Result in Continued Enforcement for Years to Come

In last year’s edition of EnforceMintz, we predicted that 2024 would bring an increase in False Claims Act (FCA) enforcement activity related to COVID-19 pandemic fraud. Those predictions proved correct. The COVID-19 Fraud...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

Robinson & Cole LLP

Legal Update: Key Takeaways: HHS and DOJ’s Health Care Fraud and Abuse Control Program Report

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On December 6, 2024, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) released the Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2023 (the Report). The Report...more

Hendershot Cowart P.C.

Doctors: Don’t Fall Victim To Telemedicine Fraud Schemes

Hendershot Cowart P.C. on

Telemedicine companies are supposed to facilitate medically necessary services to beneficiaries over the telephone via licensed medical professionals. In reality, however, many of these “telemedicine companies” are...more

Foley & Lardner LLP

HRSA Uninsured Program COVID-19 Services: What Were the Standards to Determine Uninsured Status?

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The Health Resources and Services Administration (HRSA) Uninsured Program (UIP), which reimbursed providers for provision of COVID-19 related services to uninsured individuals, paid out more than $24.5 billion in claims....more

The Volkov Law Group

Telehealth: A New Opportunity for Fraudsters

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Whenever new technologies emerge or new pots of government funds for assistance are available, you can count on one thing (as the sun rises and sets) – fraudsters will figure out a way to steal money from innocent persons and...more

Harris Beach Murtha PLLC

Updates Coming to OIG Compliance Program Guidance

The Department of Health and Human Services’ Office of Inspector General (“OIG”) willmodernize its Compliance Program Guidance (“CPG”) beginning at the end of calendar year 2023. The updates will be posted on the OIG website...more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | April 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for April 2023. We discuss several criminal and civil enforcement actions related to the Anti-Kickback Statute (AKS) and the...more

McDermott Will & Schulte

Healthcare Regulatory Check-up Newsletter | December 2022 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity between November 21 and December 31, 2022, including recent enforcement activity and a summary of the Office of Inspector...more

McDermott Will & Schulte

Pandemic Response Accountability Committee Report Highlights Telehealth Program Integrity Concerns

On July 20, 2022, the US Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert (Alert) concerning the fraud and abuse risks associated with healthcare practitioners entering...more

Harris Beach Murtha PLLC

OIG Enforcement Summary: August 1, 2022 – August 15, 2022

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

Harris Beach Murtha PLLC

OIG Enforcement Summary: July 16, 2022 – July 31, 2022

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

Rivkin Radler LLP

NY Pharmacy Owner Sentenced for Healthcare Fraud

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A New York woman was sentenced last month to 78 months in prison for defrauding healthcare programs, including obtaining more than $6.5 million from Medicare Part D plans and Medicaid drug plans....more

King & Spalding

OIG Principal Deputy Inspector General Speaks at AHLA Fraud and Compliance Forum

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On September 22, 2021, OIG Principal Deputy Inspector General Christi Grimm delivered a keynote speech to the American Health Law Association (AHLA) Fraud and Compliance Forum. Consistent with her remarks this spring at the...more

King & Spalding

OIG Releases Semiannual Report to Congress

King & Spalding on

On May 28, 2021, OIG released its Semiannual Report to Congress (the Report). The Report describes OIG’s work during the 6-month semiannual reporting period of October 1, 2020, through March 31, 2021 (the Semiannual Reporting...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

Foley & Lardner LLP

OIG Has Seven (Yes Seven!) Different National Telemedicine Audits

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Companies who feel the Public Health Emergency (PHE) waivers and exceptions have rendered telemedicine “immune” from compliance oversight might be surprised to learn what federal regulators have in the works. The Office of...more

Foley & Lardner LLP

Top 5 Telehealth Law Predictions for 2021

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With 2020 officially behind us, what does 2021 have in store for telemedicine and digital health policy? A year ago, our team predicted 2020 would bring “notable expansions in Medicare and Medicaid coverage” and “the...more

ArentFox Schiff

OIG Issues Fraud Alert: Should Pharma and Device Companies Cease Speaker Programs?

ArentFox Schiff on

The Department of Health and Human Services Office of the Inspector General (OIG) published a Special Fraud Alert on November 16, 2020 (the Alert) regarding a common practice within the pharmaceutical and medical device...more

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