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
7/31/2024
/ Anti-Kickback Statute ,
Beneficiaries ,
Bring Your Own Device (BYOD) ,
But For Causation ,
Compliance ,
Department of Justice (DOJ) ,
Enforcement ,
Fair Market Value ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Oral Argument ,
Physician Compensation Arrangements ,
Policies and Procedures ,
Portability ,
Settlement ,
Stark Law ,
TRICARE ,
Valuation
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
6/17/2024
/ Chronic Care Managment (CCM) ,
Coronavirus/COVID-19 ,
Damages ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
HRSA ,
Kickbacks ,
Medicaid ,
Medicare ,
Medicare Fraud ,
Penalties ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
TRICARE ,
Uninsured Patients
Georgia Laboratory Owner Pleads Guilty to Felony Anti-Kickback Statute Violations -
On February 28, the US Department of Justice (DOJ) announced the guilty plea of Andrew Maloney, who, along with his clinical laboratory...more
3/11/2024
/ Anti-Kickback Statute ,
Criminal Investigations ,
Department of Justice (DOJ) ,
Drug Testing ,
False Claims Act (FCA) ,
Federal Food Drug and Cosmetic Act (FFDCA) ,
Fines ,
Fraud ,
Guilty Pleas ,
Healthcare Fraud ,
IRS ,
Medicaid ,
Medicare Fraud ,
Opioid ,
Sentencing ,
Settlement ,
Tax Evasion ,
TRICARE
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
2/19/2024
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Criminal Conspiracy ,
False Billing ,
False Claims Act (FCA) ,
Fraud ,
Healthcare Fraud ,
Insurance Fraud ,
Mail Fraud ,
Medical Equipment ,
Medicare ,
Paycheck Protection Program (PPP) ,
Scams ,
Sentencing ,
TRICARE ,
Wire Fraud
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
12/11/2023
/ Clinical Laboratory Testing ,
Conspiracies ,
Controlled Substances ,
Criminal Convictions ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Healthcare Facilities ,
Kickbacks ,
Medicaid ,
Medicare ,
Medicare Fraud ,
Settlement ,
TRICARE ,
Wire Fraud
Three Men Sentenced for $54 Million TRICARE Fraud Scheme -
Three men were sentenced in connection with a $54 million bribery and kickback scheme involving TRICARE, a federal program that provides health insurance benefits...more
11/20/2023
/ Bribery ,
Department of Justice (DOJ) ,
False Statements ,
Fraud ,
Health Insurance ,
Healthcare Fraud ,
Kickbacks ,
Money Laundering ,
Pyramid Schemes ,
Reimbursements ,
TRICARE ,
Wire Fraud
Medical Marketer Convicted of $55 Million Fraud Scheme -
Late last week, a federal jury in the Northern District of Texas convicted Quintan Cockerell for his role in a $55 million fraud conspiracy involving TRICARE, a...more
11/6/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Criminal Convictions ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Fraud ,
Kickbacks ,
Medicaid ,
Medicaid Drug Rebate Program ,
Reimbursements ,
Settlement ,
TRICARE
DOJ’s First Criminal Securities Fraud Prosecution Related to COVID-19 Results in Eight-Year Sentence -
Mark Schena, the former president of Arrayit Corporation, a Silicon Valley-based medical technology company, was...more
10/23/2023
/ Conspiracies ,
Coronavirus/COVID-19 ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Emergency Use Authorization (EUA) ,
False Claims Act (FCA) ,
False Statements ,
Food and Drug Administration (FDA) ,
Healthcare Fraud ,
Investors ,
Kickbacks ,
Medicaid ,
Medical Technology Companies ,
Medicare Fraud ,
Restitution ,
Securities Fraud ,
Sentencing ,
Settlement ,
TRICARE ,
Wire Fraud
SCOTUS Denies Cert In Cases Addressing FCA Pleadings Requirements -
On Monday, October 17, 2022, the US Supreme Court rejected three petitions asking the Court to resolve a circuit split regarding the Rule 9(b)...more
10/21/2022
/ CIGNA ,
Denial of Certiorari ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Kickbacks ,
Medicare ,
Medicare Advantage ,
SCOTUS ,
Solicitor General ,
TRICARE ,
Whistleblowers
Lens Manufacturer Agrees To Pay $16.4 Million To Resolve Alleged Violations of the False Claims Act and Anti-Kickback Statute -
Essilor International, Essilor of America, Inc., Essilor Laboratories of America Inc., and...more
4th Circuit Affirms Dismissal of FCA Medicaid Suit Against Allergan -
On January 25, 2022, a majority of the Fourth Circuit panel affirmed the dismissal of a relator's False Claims Act complaint against Allergan Sales LLC,...more
1/31/2022
/ Allergan Inc ,
Criminal Conspiracy ,
Criminal Convictions ,
False Claims Act (FCA) ,
Fraud ,
Kickbacks ,
Mail Fraud ,
Medicaid ,
Pharmacist ,
Sentencing ,
TRICARE
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
DOJ Files Complaint in AWP False Claims Act Suit Against Pharmaceutical Ingredient Seller -
On November 8, 2021, the Department of Justice (DOJ) announced that it intervened in a qui tam suit and filed a False Claims Act...more
11/15/2021
/ Anti-Kickback Statute ,
Bribery ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
FBI ,
Fraud ,
Medical Devices ,
Medicare ,
Pharmaceutical Industry ,
Qui Tam ,
TRICARE ,
Whistleblowers
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
10/22/2021
/ Anti-Kickback Statute ,
CARES Act ,
Contractors ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
False Statements ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Paycheck Protection Program (PPP) ,
SBA ,
Settlement ,
TRICARE ,
Unemployment Benefits ,
Wire Fraud
According to court documents, the defendant admitted to, among other things, distributing unnecessary compound prescriptions by adjusting prescriptions and paying recruiters commissions for procuring prescriptions for...more
7/26/2021
/ Criminal Conspiracy ,
Cybersecurity ,
Drug Compounding ,
Foreign Corporations ,
Hackers ,
Healthcare Fraud ,
Kickbacks ,
Malware ,
SBA ,
Trade Secrets ,
TRICARE
The owner of Campbell Medical Clinic in Houston and her medical group agreed to resolve fraudulent billing allegations for $2.6 million.
Chiropractor Agrees to Pay $2.6 Million and to 10-Year Exclusion from Federal Health...more
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
5/10/2021
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Frivolous Lawsuits ,
Healthcare Fraud ,
Kickbacks ,
Medicaid ,
Medicare ,
Money Laundering ,
Settlement ,
Telemarketing ,
TRICARE
Despite Decrease in 2020 False Claims Act Recoveries, Investigations and Litigation Expected to Rise Under the Biden Administration -
As previously detailed by Arent Fox, total False Claims Act (FCA) recoveries for the...more
2/1/2021
/ Anti-Kickback Statute ,
Biden Administration ,
CARES Act ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Healthcare Fraud ,
Investigations ,
Kickbacks ,
Medicare ,
Paycheck Protection Program (PPP) ,
Recovery Plans ,
Settlement Agreements ,
TRICARE
Medical Device Manufacturer Settles Improper Payment Allegations for $18 Million -
Merit Medical Systems Inc. (MMSI), a Utah-based medical device maker, will pay $18 million to settle allegations that it engaged in a...more
10/19/2020
/ Child Care ,
Corporate Integrity Agreement ,
Department of Energy (DOE) ,
False Claims Act (FCA) ,
Fraud ,
Kickbacks ,
Mail Fraud ,
Medicaid ,
Medical Devices ,
Medicare ,
Settlement Agreements ,
Subcontractors ,
TRICARE ,
Wire Fraud
Biotechnology Company Settles False Claims Act Charges for $11.5 million -
The Acting U.S. Attorney for the Southern District of New York announced a settlement with Bio-Reference Laboratories, Inc. (“BRL”), a New...more
9/28/2020
/ Anti-Fraud Provisions ,
Anti-Kickback Statute ,
Biotechnology ,
Broker-Dealer ,
False Claims Act (FCA) ,
Fraud ,
Kickbacks ,
Medicare ,
New Jersey ,
Securities and Exchange Commission (SEC) ,
Settlement Agreements ,
TRICARE ,
Whistleblowers
Acute Care Hospital Agrees to Pay $50 Million to Settle Alleged Stark Law and Anti-Kickback Statute Violations -
On September 9, 2020, the Department of Justice (“DOJ”) announced that Wheeling Hospital Inc. (“Wheeling...more
9/14/2020
/ Anti-Kickback Statute ,
California ,
Campaign Contributions ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Fair Market Value ,
False Claims Act (FCA) ,
Fraud ,
Medicaid ,
Medicare ,
Qui Tam ,
Risk Assessment ,
Settlement Agreements ,
Stark Law ,
TRICARE ,
Wire Fraud
Drug Testing Lab Pays Nearly $12 Million to Settle False Claims Act Allegations -
On July 20, 2020, the Department of Justice (DOJ) announced a civil settlement with Sterling Healthcare Opco, LLC d/b/a Cordant Health...more
7/27/2020
/ Anti-Fraud Provisions ,
Anti-Kickback Statute ,
Corporate Integrity Agreement ,
Department of Justice (DOJ) ,
Drug Testing ,
False Claims Act (FCA) ,
Fraud ,
Inspector General ,
Kickbacks ,
Medicare ,
Securities and Exchange Commission (SEC) ,
TRICARE
COVID Relief Program Fraud Charges -
DOJ continues to announce charges against defendants accused of fraud in connection with allegedly false loan applications submitted under the Paycheck Protection Program (PPP)...more
7/20/2020
/ Bank Fraud ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
False Statements ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Loan Applications ,
Medicaid ,
Medicare ,
Paycheck Protection Program (PPP) ,
SBA ,
Skilled Nursing Facility ,
Tax Returns ,
TRICARE ,
Wire Fraud
DOJ Announces $72.3 Million False Claims Act Settlement -
Oklahoma Center for Orthopaedic and Multi-Specialty Surgery, its part-owner and management company, a physician group, and other affiliated entities and...more
7/13/2020
/ Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Genetic Testing ,
Kickbacks ,
Medicaid ,
Medicare ,
Qui Tam ,
Settlement ,
stark ,
TRICARE ,
Whistleblowers
SBA and Department of Treasury Announce Disclosure of PPP Recipients -
After weeks of mounting public and congressional pressure, on Friday, June 19, the SBA and Department of Treasury announced that it will make...more
6/26/2020
/ Department of Justice (DOJ) ,
Disclosure ,
Financial Institutions ,
Food and Drug Administration (FDA) ,
Fraud ,
Kickbacks ,
NAICS ,
Paycheck Protection Program (PPP) ,
Prescription Drugs ,
SBA ,
TRICARE ,
U.S. Treasury ,
Wire Fraud