News & Analysis as of

Health Insurance Fraud and Abuse Health Care Providers

American Conference Institute (ACI)

[Event] 16th Annual Advanced Forum on Managed Care Disputes and Litigation - May 1st - 2nd, Chicago, IL

Join the industry’s top litigators and leading plan counsel at ACI’s 16th Annual Advanced Forum on Managed Care Disputes and Litigation, for two days of discussions designed to address emerging areas of concern for MCOs in...more

Troutman Pepper Locke

AGs Take Action Regarding Medicaid Fraud

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This month, two attorneys general (AGs) have settled False Claims Act investigations with two separate companies in the health care industry. Both settlements were notable in their own right....more

The Volkov Law Group

Oak Street Health Pays $60 Million to Resolve False Claims Act Violations

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Federal whistleblowers have been exposing health care fraud for years.  The False Claims Act (“FCA”) contains robust whistleblower provisions and protections that reward whistleblowers with financial payouts. The process for...more

The Volkov Law Group

The Continuing Plague of Healthcare Fraud

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Healthcare fraud is an ever-growing constant in our economy.  It is a battle that presents new and exponential challenges.  The U.S. Department of Justice, the HHS-Office of Inspector general and State Attorneys’ General all...more

Robinson+Cole Health Law Diagnosis

DOJ Charges 36 Defendants in Connection with Telemedicine and Clinical Laboratory Fraud and Abuse Schemes

On June 27, 2024, the Department of Justice (DOJ) announced its 2024 National Health Care Fraud Enforcement Action, which resulted in criminal charges against 193 defendants for alleged participation in various health care...more

McDermott Will & Schulte

[Webinar] The Rise of the Payvider: Joint Ventures Between Health Systems and Payors - October 19th, 1:00 pm - 2:00 pm EDT

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The emergence of joint ventures between health systems and payors is quickly reshaping the healthcare sector as we know it—presenting both new complexities and fresh opportunities for the changemakers involved....more

Robinson+Cole Health Law Diagnosis

New York OMIG Issues 2022 Annual Report

On Monday, October 2, 2023, the New York Office of the Medicaid Inspector General (OMIG) published its Annual Report for 2022. The Report details the various efforts that New York’s Medicaid program undertook in 2022 to...more

Epstein Becker & Green

Physicians Beware! Groups Providing DME, Prosthetic Devices, and Other Medical Supplies to Their Medicare Patients Risk Violating...

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When the COVID-19 Public Health Emergency (“PHE”) ended on May 11, 2023, many physician groups furnishing certain medical equipment, devices, and/or supplies to their Medicare patients became in violation of the federal...more

Carlton Fields

7th Cir. Holds Insurance Coverage Applies to Settlement Payments for Alleged Anti-Kickback and False Claims Act Violations

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On May 3, 2023, the Seventh Circuit Court of Appeals, in Astellas US Holding Inc. v. Federal Insurance Co., held that a liability insurer was required to contribute its limits toward its insured’s payment to settle potential...more

Akerman LLP

False Claims Act 2022 in Review

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The U.S. government continued to earn its longstanding reputation for its vigorous enforcement of the False Claims Act (FCA) in 2022, either directly or through relator proxies. The Department of Justice (DOJ) recorded the...more

Mintz - Health Care Viewpoints

OIG Issues Favorable Advisory Opinion on Gift Cards to Incentivize Patients to Return Samples for At-Home Colorectal Cancer...

The Office of Inspector General for the Department of Health and Human Services (OIG) recently issued yet another favorable Advisory Opinion on the use of gift cards to motivate patients to receive medically necessary or...more

Akerman LLP - Health Law Rx

The Trebling Effect of (Some) False Claims Act Trials

There are multiple components to the risk defendants must consider when faced with going to trial for a matter involving the False Claims Act (FCA). Setting aside the incalculable impact that litigation can have on business...more

Jones Day

DOJ Announces Second-Largest Annual Total Recoveries in False Claims Act History

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DOJ recovers a record $5.6 billion from FCA cases in 2021, the largest annual total since 2014. - The United States Department of Justice Civil Division ("DOJ") recently announced a recovery of more than $5.6 billion in...more

Morgan Lewis - Health Law Scan

$1 Million Settlement Reached in AseraCare FCA Case

In an action especially significant to hospice providers but also other healthcare providers regarding the determinations of medical necessity for Medicare billing purposes, the US Department of Justice (DOJ) and AseraCare...more

McDermott Will & Schulte

[Webinar] 2019 Q4 Healthcare Enforcement Roundup - February 5th, 2:30 pm ET

The final quarter of 2019 brought forward new guidance and proposed rules with major implications for healthcare companies, enforcement developments in healthcare private equity investing and opioid litigation matters, among...more

Holland & Knight LLP

OIG Considers Drug Pricing History in an Unfavorable Advisory Opinion on Free Drugs

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• The OIG issued an unfavorable advisory opinion on a proposed program by which a marketer would provide free drugs to hospitals to utilize in an inpatient setting to treat infantile epilepsy. • Contrary to the typical...more

Bass, Berry & Sims PLC

Healthcare Fraud & Abuse Review 2017

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A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

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