News & Analysis as of

Medicare Fraud Enforcement

Bass, Berry & Sims PLC

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

Bass, Berry & Sims PLC on

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

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

Foley Hoag LLP

Health Care Fraud Enforcement in 2025

Foley Hoag LLP on

We kick off our annual Year in Preview series with a comprehensive look at health care fraud enforcement in 2025. This post proceeds in three parts. First, we explore what the second Trump administration might bring, looking...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

ArentFox Schiff

Investigations Newsletter: Biomedical Company Avoids DOJ Prosecution After First Ever Voluntary Corporate Self-Disclosure of Fraud...

ArentFox Schiff on

Biomedical Company Avoids DOJ Prosecution After First Ever Voluntary Corporate Self-Disclosure of Fraud Under NSD Enforcement Policy - On May 22, the US Department of Justice (DOJ) announced that it will not prosecute a...more

Morrison & Foerster LLP

DOJ Releases 2024 COVID-19 Fraud Enforcement Task Force Report

On April 9, 2024, the United States Department of Justice (DOJ) released a report on the COVID-19 Fraud Enforcement Task Force (“Task Force”), by far DOJ’s most comprehensive review of the Task Force since its creation in...more

Snell & Wilmer

Scope of FCA Liability Illustrated In Recent Actions Against Higher Education Institutions

Snell & Wilmer on

In the past five years, the Federal Government and “Qui Tam” Realtors have ramped up False Claims Act (“FCA”) actions against higher education institutions. These actions highlight the scope and breadth of potential FCA...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

Wiley Rein LLP

DOJ’s FY 2022 False Claims Act Report: Smaller Dollars but More Cases and Enforcement Priorities

Wiley Rein LLP on

On February 7, 2023, the Department of Justice (DOJ) announced that FY 2022 yielded just $2.2 billion in spoils from False Claims Act (FCA) judgments and settlements—the smallest haul since 2008 and a precipitous drop from...more

King & Spalding

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

King & Spalding on

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

Alston & Bird

Telehealth Turbulence: Explosive Expansion Coincides with Emerging Enforcement Priorities

Alston & Bird on

Loosening regulations on telehealth during the coronavirus pandemic has, unsurprisingly, led to a boom in telehealth use. At the same time, telehealth has emerged as a key enforcement initiative of the Department of Justice...more

Seyfarth Shaw LLP

Insurers, ERISA Plans and Other Payors:  Beware of COVID-19 Fraud Schemes!

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On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) issued an alert to the public about fraud schemes related to the novel coronavirus (COVID-19)....more

BakerHostetler

The Deeper Dive: C-Suite to Prison Pipeline

BakerHostetler on

In recent years, the U.S. Department of Justice (DOJ) has been criticized for failing to prosecute executives for fraud, particularly in the financial sector. In response, the DOJ has begun to more heavily emphasize...more

The Volkov Law Group

The Intractable Problem of Medicare Fraud

The Volkov Law Group on

You have to admire the vigilance and dedication of prosecutors and law enforcement investigators who fight Medicare fraud. There is no question that they have ramped up enforcement and promoted a strong message of deterrence....more

Mintz - Health Care Viewpoints

Health Care Enforcement in 2012: A Year in Review

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

The Volkov Law Group

Privatizing Health Insurance Companies For Anti-Fraud Enforcement

The Volkov Law Group on

The federal government faces overwhelming challenges in trying to stem the tide of fraud in the health care system. The problem is massive, and even with the increase in resources, and adoption of new tools to fight fraud,...more

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