Daily Compliance News: May 16, 2025, The Ethics Nightmare Edition
It’s been more than two weeks since the release of the CY 2026 Medicare Physician Fee Schedule (PFS) proposed rule. We’ve had a chance to digest our initial helping and now we’re ready for seconds. We thought we would see...more
IT Company Resolves FCA Allegations for Nearly $15 Million - On July 14, the US Department of Justice (DOJ) announced that Hill ASC Inc., an information technology (IT) staffing company, agreed to pay $14.75 million to...more
CEO of Health Care Software Company Convicted of $1 Billion in Medicare Fraud - A federal jury in Miami convicted Gary Cox, the CEO of Power Mobility Doctor Rx, LLC, of six health care-fraud-related counts for his role in...more
DOJ Plans to Use the FCA to Attack DEI Initiatives - On May 19, the US Department of Justice (DOJ) announced a novel use of the False Claims Act (FCA) to enforce Trump Administration policies against antisemitism, gender...more
Welcome to the Daily Compliance News. Each day, Tom Fox, the Voice of Compliance brings to you compliance related stories to start your day. Sit back, enjoy a cup of morning coffee and listen in to the Daily Compliance News....more
Seabrook Rehab Center to Pay $19.75 Million for FCA Violations - A New Jersey drug and alcohol rehabilitation center, Seabrook, will pay $19.75 million to resolve allegations that it violated the False Claims Act (FCA) by...more
The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced on April 23 that Genexe, LLC (doing business as Genexe Health) and its parent company, Immerge, Inc., along with two of their executive...more
The Department of Justice announced this week that California-based primary care provider Seoul Medical Group, Inc. (SMG), SMG’s former president and majority owner, and California-based radiology group Renaissance Imaging...more
Jury Clears SuperValu of Liability in Whistleblower FCA Prescription Pricing Case - A federal jury in Illinois recently found SuperValu not liable in a whistleblower lawsuit that accused the company of overcharging the...more
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
Medicare reimbursement for hospital outpatient services has come under attack in recent years, with a focus on “site neutral” payment policies that would pay hospitals for outpatient services furnished in off-campus locations...more
On January 15, 2025, the U.S. Department of Justice (DOJ) issued a press release announcing its fiscal year (FY) 2024 False Claims Act (FCA) recoveries and reported that settlements and judgments exceeded $2.9 billion in...more
Florida Telemarketer Sentenced to 15 Years in Prison for $67 Million Medicare Fraud Scheme - On December 6, Jose Goyos was sentenced to 15 years in prison for his role in managing a deceptive telemarketing scheme to...more
Kenneth Fishberger, a Long Island internist with nearly 50 years of medical experience, recently pleaded guilty to conspiracy to commit healthcare fraud. Prosecutors revealed that from 2013 to 2019, Fishberger ordered...more
Seventh Circuit Considers When Legal Marketing Transforms Into Illegal Kickbacks - On December 4, the US Court of Appeals for the Seventh Circuit heard oral arguments regarding whether the January 2023 jury conviction of...more
In September 2024, the Ninth Circuit reversed in part a district court’s dismissal of an action under the False Claims Act (FCA or the “Act”) for lack of jurisdiction under the Act’s First-to-File Rule and held that the...more
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
Health Care Fraud and Money Laundering of $18 Million Leads to Prison Sentence for New York Pharmacy Owners - Two pharmacy owners from New York have been sentenced for using their pharmacies to submit fraudulent claims to...more
Chicago Laboratory Owner Charged with Defrauding Medicare in $60 Million COVID-19 Test Kit Scheme - The Chicago-based owner of two laboratories, Zoom Labs Inc. and Western Labs Co., has been charged with health care fraud...more
This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for April 2024. We discuss several US Department of Health and Human Services (HHS) agency actions, including the Calendar Year (CY) 2025...more
Former NBA player Glen “Big Baby” Davis was sentenced to 40 months in prison after being convicted for his role in a scheme to defraud the NBA healthcare plan. Davis’ sentence comes almost a year after the scheme’s...more
DOJ Secures Plea in $50 Million Medicare Fraud and Kickback Scheme - On April 26, the US Department of Justice (DOJ) announced that Manishkumar Patel pleaded guilty to charges related to a $50 million health care fraud and...more
Disgraced Crypto Mogul Bankman-Fried Sentenced to 25 Years in Prison - On March 28, Judge Lewis Kaplan of the United States District Court for the Southern District of New York handed down a substantial term of...more
Telemedicine Owner Pleads Guilty to $136 Million Medicare Fraud - A licensed nurse practitioner in New Jersey, Jean Wilson, pleaded guilty to conspiracy to commit health care fraud and wire fraud. According to court...more
The following is a summary of selected 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...more