News & Analysis as of

Medicare Medicare Fraud

McGuireWoods LLP

Seventh Circuit Allows Percentage-Based Marketing Relationship

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On April 14th, 2025, the U.S. Court of Appeals for the Seventh Circuit reversed the Anti-Kickback Statute (AKS) conviction of Mark Sorensen, the owner and operator of a Medicare-registered durable medical equipment...more

McDermott+

Back for seconds: digital health policies in the CY 2026 PFS proposed rule

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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

ArentFox Schiff

Investigations Newsletter: Seabrook Rehab Center to Pay $19.75 Million for FCA Violations

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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

ArentFox Schiff

Investigations Newsletter: Jury Clears SuperValu of Liability in Whistleblower FCA Prescription Pricing Case

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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

McDermott Will & Schulte

Hospital Provider-Based Compliance: Top 10 Myths and Truths

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

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

ArentFox Schiff

Investigations Newsletter: Chicago Laboratory Owner Charged with Defrauding Medicare in $60 Million COVID-19 Test Kit Scheme

ArentFox Schiff on

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

Benesch

From the NBA Finals to Federal Prison - “Big Baby” Sentenced to 40 months in NBA Healthcare Plan Scheme

Benesch on

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

Dickinson Wright

NY Doctor Indicted for Medicare Fraud Related to Genetic Testing and Equipment

Dickinson Wright on

The government is continuing to take a close look at laboratory testing in the wake of the COVID-19 pandemic. On February 21, 2024, a federal grand jury in New Jersey issued a superseding indictment against a New York...more

ArentFox Schiff

Investigations Newsletter: Hospital Executive and Three Physicians to Pay More Than $880,000 to Resolve Kickback Allegations

ArentFox Schiff on

Hospital Executive and Three Physicians to Pay More Than $880,000 to Resolve Kickback Allegations - On Monday, December 4, 2023, a Lexington, Texas, hospital executive and three health care providers agreed to pay more...more

Akin Gump Strauss Hauer & Feld LLP

Akin Intelligence - November 2023

Welcome to the November edition of Akin Intelligence. Looking back, October 2023 may be remembered as the month when the U.S. government tried to assume the mantle of global leadership on responsible artificial intelligence...more

ArentFox Schiff

Investigations Newsletter: FTX Founder’s Fraud Trial Continues in Manhattan Court

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FTX Founder’s Fraud Trial Continues in Manhattan Court - The criminal trial of Sam Bankman-Fried continued this week in Manhattan where the FTX founder faces several charges, including fraud, conspiracy, and money...more

ArentFox Schiff

Investigations Newsletter: Federal Judge Rules Government Must Demonstrate “But-For” Causation for Anti-Kickback Statute Claims

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Federal Judge Rules Government Must Demonstrate “But-For” Causation for Anti-Kickback Statute Claims - On September 27, 2023, Chief Judge Dennis Saylor of the US District Court for the District of Massachusetts ruled that...more

Harris Beach Murtha PLLC

HHS Office of Inspector General September 2023 Enforcement Activity

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

Harris Beach Murtha PLLC

HHS Office of Inspector General August 2023 Enforcement Activity

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

ArentFox Schiff

Investigations Newsletter: Government Brings FCA Action Against Laboratory Companies

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Government Brings FCA Action Against Laboratory Companies - On July 18, 2023, the US Department of Justice (DOJ) announced it has filed a complaint against multiple laboratory companies and their owner, Patrick...more

ArentFox Schiff

Investigations Newsletter: $31 Million Medicare Fraud Scheme Results in Two Convictions

ArentFox Schiff on

$31 Million Medicare Fraud Scheme Results in Two Convictions - On January 30, 2023, a federal jury found two Florida physicians guilty for their involvement in a scheme to defraud Medicare of over $31 million. The two...more

ArentFox Schiff

Investigations Newsletter: Pharmacy Owners Plead Guilty to COVID Fraud and Money Laundering Scheme

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Pharmacy Owners Plead Guilty to COVID Fraud and Money Laundering Scheme - Two New York men pled guilty for their alleged involvement in a complex money laundering conspiracy to launder proceeds from a fraudulent health...more

ArentFox Schiff

Investigations Newsletter: Jury Orders Eli Lilly To Pay $61 Million

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Jury Orders Eli Lilly To Pay $61 Million - A federal jury in Illinois found that, beginning around 2004, drug manufacturer Eli Lilly deliberately underpaid rebates to Medicare programs by excluding retroactive drug prices...more

Oberheiden P.C.

Medicare TPE Audits: 7 Common Questions Answered

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The Centers for Medicare and Medicaid Services (CMS) and its audit contractors have recently increased their use of Targeted Probe and Educate (TPE) audits to target providers suspected of improperly billing Medicare. While...more

ArentFox Schiff

Investigations Newsletters: US Supreme Court Requests Solicitor General's Views in FCA Rule 9(b) Context

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US Supreme Court Requests Solicitor General’s Views in FCA Rule 9(b) Context - On May 16, 2022, the US Supreme Court requested a brief from the US Solicitor General on the level particularly required by Federal Rule of...more

Oberheiden P.C.

Federal Authorities Place Cardiovascular Stress Testing Under the Microscope

Oberheiden P.C. on

Cardiovascular stress testing to diagnose patients with coronary artery disease (CAD) and other related types of conditions can be a highly-effective tool in many cases. In fact, many cardiologists routinely recommend stress...more

Oberheiden P.C.

CMS and DOJ are Scrutinizing Medicare Billings for Amniotic Injections

Oberheiden P.C. on

The Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Justice (DOJ) are scrutinizing health care providers’ Medicare billings for amniotic injections. These injections are only eligible for Medicare...more

Polsinelli

DOJ Telemedicine Offensive Pushes Forward with New Charges

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For the past two years, telemedicine companies, durable medical equipment suppliers, pharmacies, and individuals and entities that market to such entities have been at the center of DOJ gunsights. In 2019, the Department...more

King & Spalding

U.S. Supreme Court Declines to Review False Claims Act Materiality Standard

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On October 5, 2020, the U.S. Supreme Court declined to review a case questioning the materiality standard for Medicare fraud cases under the False Claims Act (FCA). The case involved allegations that Lawrence Memorial...more

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