News & Analysis as of November 15, 2024

Anti-Kickback Statute › Healthcare › Fraud

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The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of federal healthcare program business. The... more +

The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of federal healthcare program business. The statute aims to prevent situations where government officials channel federal healthcare dollars towards particular providers, who have offered or given the official a personal benefit. Penalties for violation of the Anti-Kickback statute apply to both sides of a prohibited transaction and can include jail time and steep monetary fines. less -

Investigations Newsletter: Precision Lens Pays $12 Million to Resolve FCA and AKS Violations

ArentFox Schiff on 8/5/2024

Precision Lens Pays $12 Million to Resolve FCA and AKS Violations - Late last week, Precision Lens and the estate of its former principal agreed to pay $12 million to resolve allegations regarding violations of the False...more

A Pharmacist's Guide To Prescription Drug Fraud Investigations

Hendershot Cowart P.C. on 3/22/2024

Prescription drug fraud has long been a focus for government regulators, but it has taken on new significance in the wake of America’s opioid crisis. The U.S. Department of Justice (DOJ), Department of Health and Human...more

DOJ Releases Annual Civil Fraud Recovery Statistics and Results…A Look Behind the Numbers

Bass, Berry & Sims PLC on 2/26/2024

On February 22, the Department of Justice (DOJ) released its annual report of civil fraud recoveries for FY2023, along with a press release highlighting DOJ’s civil enforcement efforts. Our top ten observations from...more

Health-Care Fraud Scrutiny Heats Up For Companies, Providers

Foley & Lardner LLP on 1/4/2024

This year will see a continued proliferation of enforcement against health-care fraud, with old and new theories. Some hot spots for enforcement will involve cases about new technologies; data outliers; entities perceived as...more

Government Investigations Team Insights - February 2022

Arnall Golden Gregory LLP on 2/28/2022

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. In this edition, we analyze a recent Eleventh Circuit decision addressing False Claims Act penalties and the...more

False Claims Act - 2021 Year in Review

Bradley Arant Boult Cummings LLP on 2/3/2022

The year 2021 marks the 10th anniversary of the Bradley False Claims Act Year in Review. In that decade, much has remained the same in FCA enforcement. To start with the obvious: It continues to result in billions of dollars...more

Tenet Healthcare Settles Fraud Case for $514 Million

The Volkov Law Group on 10/25/2016

If you work in compliance in the healthcare industry, you have a tough job. The number and variety of risks that healthcare providers face is daunting. The False Claims Act is a mighty weapon in the hands of federal...more

OIG Releases Special Fraud Alert on Laboratory Payments to Physicians

Ballard Spahr LLP on 6/27/2014

The Office of the Inspector General (OIG) for the Department of Health and Human Services recently issued a Special Fraud Alert regarding laboratory payments to referring physicians. The Special Fraud Alert reaffirms OIG’s...more

Do You Know What Your Hospital Board Members Are Doing?

BakerHostetler on 4/7/2014

David Chandler was appointed to serve as chairman of Tri-Lakes Medical Center (TLMC), a community hospital in Panola County, Mississippi. As chairman, Chandler set board meeting agendas, regularly dealt with the administrator...more

HHS's Mixed Messages: Identifying a Federal Healthcare Program When You See It

BakerHostetler on 11/15/2013

Recent seemingly contrary determinations by the U.S. Department of Health and Human Services (HHS) have fueled industry speculation regarding whether qualified health plans (QHPs) available on the health insurance exchanges...more

OIG Special Fraud Alert Labels Physician-Owned Distributorships (PODs) as “Inherently Suspect”

Davis Wright Tremaine LLP on 4/22/2013

The U.S. Department of Health & Human Services, Office of Inspector General (the “OIG”) issued a Special Fraud Alert (“Alert”) on March 26, underscoring its heightened focus on fraud and abuse risks posed by physician-owned...more

OIG Special Fraud Alert on Physician-Owned Distributorships

Bradley Arant Boult Cummings LLP on 4/16/2013

On March 26, 2013, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert entitled “Physician-Owned Entities.” The Alert is consistent with an ongoing theme of concern...more

OIG Issues Special Fraud Alert on Business Arrangements with Physician-Owned Entities

Proskauer Rose LLP on 4/15/2013

On March 26, the HHS Office of Inspector General (OIG) issued a Special Fraud Alert (Fraud Alert) reiterating its long-standing concern that the opportunity for a referring physician to earn a profit by investing in a venture...more

OIG Calls PODs "Inherently Suspect"

Baker Donelson on 3/29/2013

Making its most strongly worded statement to date, the Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert on Physician-Owned Entities on March 26, 2013, calling...more

Health Care Enforcement in 2012: A Year in Review

Mintz - Health Care Viewpoints on 2/26/2013

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 Healthcare Industry And The Voluntary Disclosure Process

The Volkov Law Group on 2/21/2013

It is always important to consider how different parts of the government handle voluntary disclosures. The FCPA enforcement initiative has been largely the result of the voluntary disclosure process, and the government...more

OIG: Cardiac Catheterization Arrangement Between Hospital and Physicians Not Subject to Sanctions

King & Spalding on 1/18/2013

On January 7, 2013, HHS OIG published a favorable advisory opinion on a management arrangement between a hospital and a cardiology group related to the provision of certain cardiac catheterization services at the hospital. ...more

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