News & Analysis as of

Medicare TRICARE Healthcare Fraud

Troutman Pepper Locke

State AGs Join $202M Settlement Over HIV Drug Kickback

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On July 16, 49 attorneys general (AGs) announced that they joined a $202 million settlement with Gilead Sciences, Inc. (Gilead). Previously announced by the Department of Justice in April, the settlement resolved allegations...more

Venable LLP

EKRA Has Teeth: Ninth Circuit Upholds Lab Operator’s Criminal Conviction for Paying Marketers for Referrals

Venable LLP on

In a matter of first impression, the Ninth Circuit Court of Appeals interpreted the scope of the 2018 Eliminating Kickbacks in Recovery Act (EKRA) in the context of a lab operator who allegedly paid marketers to induce...more

Dorsey & Whitney LLP

New State-Level Anti-Kickback Statute Expands Minnesota AG’s Power to Prosecute Healthcare Fraud

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On May 23, 2025, Minnesota Governor Tim Walz signed the Human Services omnibus policy bill into law, which included in part, the addition of a new statutory provision in the state’s criminal code, Chapter 609....more

ArentFox Schiff

Investigations Newsletter: First Circuit Joins Sixth and Eighth Circuits in Adopting Heightened, But-For Causation Standard for...

ArentFox Schiff on

First Circuit Joins Sixth and Eighth Circuits in Adopting Heightened, But-For Causation Standard for AKS-Based FCA Claims - On February 18, the US Court of Appeals for the First Circuit became the latest court to agree...more

Hendershot Cowart P.C.

Texas Healthcare Providers Paid $21.3 Million to Resolve Stark Law Violations in 2024

Hendershot Cowart P.C. on

Healthcare fraud enforcement continues to be a top priority for federal authorities, with Stark Law violations remaining under particular scrutiny. The complex nature of physician self-referral regulations, combined with...more

Mintz - Health Care Viewpoints

EnforceMintz — Additional Health Care Provider Joins the OIG’s “Heightened Scrutiny” List in 2024

The HHS Office of Inspector General (OIG), in connection with its enforcement responsibilities, must exclude a party from the federal health care programs if the party is found to have violated certain federal laws. This type...more

McAfee & Taft

Gavel to Gavel: Justice Department takes aim at private health plan fraud

McAfee & Taft on

Historically, the U.S. Department of Justice has directed its efforts on combatting healthcare fraud by focusing on persons and companies who defraud or attempt to defraud federally funded healthcare programs, such as...more

ArentFox Schiff

Investigations Newsletter: UCHealth Settles FCA Violations for $23 Million

ArentFox Schiff on

UCHealth Settles FCA Violations for $23 Million - On November 12, the US Department of Justice (DOJ) announced that University of Colorado Health (UCHealth) agreed to resolve allegations that it violated the False Claims...more

Troutman Pepper Locke

Precision Toxicology Agrees to Pay $27M Over Drug Testing and Kickback Allegations

Troutman Pepper Locke on

On October 15, Maryland Attorney General Anthony G. Brown announced that his office reached a $27 million settlement with Precision Toxicology to resolve allegations that it submitted false claims to government health...more

Rivkin Radler LLP

CA Physician and Practice Resolve FCA Allegations for $3.8 Million

Rivkin Radler LLP on

The U.S. Attorney’s Office for the Southern District of California announced on October 11 that Dr. Janette Gray and her former medical practice, The Center for Health & Wellbeing in San Diego, resolved False Claims Act (FCA)...more

ArentFox Schiff

Investigations Newsletter: FCA Enforcement & Compliance Digest — Summer 2024 False Claims Act Newsletter

ArentFox Schiff on

Welcome to the Summer 2024 issue of “FCA Enforcement & Compliance Digest,” our quarterly newsletter in which we compile essential updates on False Claims Act (FCA) enforcement trends, litigation, agency guidance, and...more

ArentFox Schiff

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

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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

ArentFox Schiff

Investigations Newsletter: Former Healthcare Executives Convicted for Health Insurance Policy Fraud Scheme

ArentFox Schiff on

Former Healthcare Executives Convicted for Health Insurance Policy Fraud Scheme - Steven Dorfman, the former chief executive officer and owner of the Florida-based healthcare company Simple Health, and John Sand, a former...more

The Volkov Law Group

BioTek, its CEO, Chaitanya Gadde, and Physician, Dr. David Tabby, Agreed to Pay $20 Million to Resolve Anti-Kickback Violations

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The reach of the Anti-Kickback Statute and the False Claims Act is broad.  As a result, AKS liability is a real and significant risk for healthcare companies and providers. Healthcare companies and providers have to resolve...more

Morrison & Foerster LLP

True Facts About False Claims: MoFo's FCA Newsletter - October 2023

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Designed for busy in-house counsel and compliance professionals, this newsletter seeks to bring you up to speed on key federal and state False Claims Act (FCA) developments, with links to primary resources. Each quarter, we...more

Rivkin Radler LLP

Fraud Week: Kickbacks for Home Healthcare Referrals

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The U.S. Department of Justice (DOJ) announced on October 18 that Oklahoma-based Carter Healthcare LLC and its affiliates, plus two executives, agreed to pay a total of over $30 million to resolve two separate qui tam cases....more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | September 2022 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity between August 21 and September 20, 2022, including a guilty plea from a telemedicine physician who wrote prescriptions for...more

Mintz - Health Care Viewpoints

False Claims Act Settlements and Judgments Exceed $5.6 Billion in Fiscal Year 2021

The Department of Justice announced in a February 1, 2022 press release (Press Release) that it obtained more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims in the fiscal year...more

ArentFox Schiff

Investigations Newsletter: Texas Man Sentenced to More Than Nine Years in Prison for COVID-19 Fraud Scheme

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Texas Man Sentenced to More Than Nine Years in Prison for COVID-19 Fraud Scheme - After pleading guilty to two charges of wire fraud and money laundering, a Texas man was sentenced to 110 months in prison for his scheme to...more

ArentFox Schiff

Investigations Newsletter: Contractor to Pay Over $4 Million to Settle FCA Violations

ArentFox Schiff on

CEO of Defunct Medical Testing Lab to Pay $1.1 Million to Settle FCA and AKS Case - Jae Lee, the former CEO of defunct Northwest Physicians Laboratory (NWPL), agreed to pay $1.1 million to resolve allegations that he...more

Proskauer - Health Care Law Brief

False Claims Act Spotlight (1 of 3): Sub-Regulatory Guidance Subjugated No More in FCA Enforcement Actions

The False Claims Act (“FCA”) is a punitive civil statute that acts as the federal government’s primary tool for combatting fraud in government health care programs, such as Medicare, Medicaid, and Tricare. In fiscal year 2020...more

Oberheiden P.C.

Seven Points to be Aware of for Durable Medical Equipment Company Compliance

Oberheiden P.C. on

Durable medical equipment (DME) is particularly important for many Medicare beneficiaries. However, companies that manufacture and sell DME need to be careful because there are strict federal regulations outlining almost...more

ArentFox Schiff

Investigations Newsletter: Pharmaceutical Company Agrees to Pay $12.6 Million to Settle FCA Allegations Involving Kickbacks

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Pharmaceutical Company Agrees to Pay $12.6 Million to Settle FCA Allegations Involving Kickbacks - On Tuesday, the Department of Justice announced a $12.6 million settlement with Incyte Corporation, a Delaware...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

Holland & Knight LLP

Healthcare Law Update: April 2021

Holland & Knight LLP on

William F. Gould In United States v. Merino, No. 19-50291, 2021 WL 754589 (9th Cir. Feb. 26, 2021), the court of appeals reversed the conviction of Marina Merino of conspiracy to commit healthcare fraud in violation of 18...more

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