News & Analysis as of September 18, 2024

Medicare

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Read guidance, analysis, and updates on the myriad issues arising from the global response to the COVID-19 pandemic. Updated hourly every day, the insights published here are written by leading lawyers and law firms helping to make sense of insurance, employment, tax, securities, M&A, risk management, and every other consideration touched by this crisis. Follow the channel for a daily email brief of the latest and best updates. less -

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

ArentFox Schiff on 6/17/2024

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

Lab Owner Pleads Guilty in Covid Test Kit Fraud Scheme

Rivkin Radler LLP on 5/9/2024

Robert Clark of Pompano Beach, Florida recently pleaded guilty to his role in a Medicare fraud scheme. Clark and his co-conspirators purchased Medicare Beneficiary Identification numbers unlawfully and then billed Medicare...more

DOJ Releases 2024 COVID-19 Fraud Enforcement Task Force Report

Morrison & Foerster LLP on 4/25/2024

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

FY 2023 False Claims Act Recoveries: $2.67 Billion In Recoveries And Over $349 Million In Awards To Whistleblowers

Pietragallo Gordon Alfano Bosick & Raspanti,... on 2/27/2024

On February 22, 2024, the Department of Justice (“DOJ”) published its annual review of cases and recoveries under the False Claims Act. Through the end of fiscal year 2023, total recoveries (across all years) under the False...more

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

ArentFox Schiff on 2/19/2024

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

Federal Judge Cites Ambiguous Coding Guidance, Vacates Doctor's Healthcare Fraud Conviction

Holland & Knight LLP on 1/2/2024

A federal judge recently exposed weaknesses in the U.S. Department of Justice's (DOJ) criminal healthcare fraud enforcement efforts by vacating a jury's conviction of a prominent Maryland doctor. On Aug. 4, 2023, a federal...more

Federal Judge Acquits Physician Following Criminal E/M Fraud Conviction at Trial

Husch Blackwell LLP on 12/29/2023

As previously reported in this post, criminal trials premised on upcoding evaluation and management (E/M) service codes are extremely rare. The Justice Department took that rare step in Maryland in connection with a practice...more

HHS Office of Inspector General August 2023 Enforcement Activity

Harris Beach PLLC on 9/8/2023

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

Investigations Newsletter: Walgreens Medicaid Fraud Case Kicked Back to Trial Court

ArentFox Schiff on 8/21/2023

Walgreens Medicaid Fraud Case Kicked Back to Trial Court - On August 15, 2023, the US Court of Appeals for the Fourth Circuit issued an opinion reversing a district judge’s dismissal of False Claims Act (FCA) claims...more

Physicians Beware! Groups Providing DME, Prosthetic Devices, and Other Medical Supplies to Their Medicare Patients Risk Violating...

Epstein Becker & Green on 8/14/2023

When the COVID-19 Public Health Emergency (“PHE”) ended on May 11, 2023, many physician groups furnishing certain medical equipment, devices, and/or supplies to their Medicare patients became in violation of the federal...more

Healthcare Regulatory Check-Up Newsletter | May 2023 Recap

McDermott Will & Emery on 6/23/2023

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for May 2023. We discuss several criminal and civil enforcement actions that involve violations of the False Claims Act (FCA)...more

While Remote Supervision Remains Available for Direct Supervision, Be Mindful of the Other “Incident to” Requirements

Bass, Berry & Sims PLC on 5/12/2023

With the May 11, 2023 expiration of the federal public health emergency (PHE) for COVID-19, many operational flexibilities healthcare providers used during the PHE will now sunset. Some flexibilities end immediately while...more

[Virtual Event] Columbus & Indianapolis Regional Healthcare Compliance Conference - June 2nd, 8:25 am - 4:30 pm ET

Health Care Compliance Association (HCCA) on 5/11/2023

General and specialty compliance education from the comfort of your home or office - HCCA’s Regional Healthcare Compliance Conferences provide practitioners with virtual compliance learning that covers a wide variety of...more

COVID-19 Fraud Enforcement Remains Priority for Federal Law Enforcement

Bradley Arant Boult Cummings LLP on 5/1/2023

On April 20, 2023, the Department of Justice announced criminal charges against 18 defendants in nine federal districts, alleging over $490 million in alleged theft from federally funded COVID-19 relief programs. This clearly...more

Fraud Week: DOJ Announces COVID-Related Fraud Sweep

Rivkin Radler LLP on 4/25/2023

The U.S. Department of Justice (DOJ) announced on April 20 that it has brought criminal charges against 18 defendants across the U.S. for various fraud schemes related to the COVID-19 pandemic. The DOJ seized more than $16...more

McDermott Health 2023 Annual Report - Digital Health: 2022 Year in Review

McDermott Will & Emery on 3/21/2023

Digital health is one of the fast-growing segments of the healthcare market, with patients, clinicians and regulators increasingly aligned behind the opportunities that digitization presents. Over the last three years,...more

Key Insights from DOJ’s False Claims Act Statistics for Fiscal Year 2022

Bradley Arant Boult Cummings LLP on 2/17/2023

The Department of Justice (DOJ) released its annual summary of False Claims Act (FCA) recoveries for the prior fiscal year, and the data points to a number of notable trends. Although DOJ brought in the second-highest...more

Investigations Newsletter: Medical Device Company to Pay Over $700,000 To Resolve Criminal Allegations

ArentFox Schiff on 1/6/2023

Medical Device Company to Pay Over $700,000 To Resolve Criminal Allegations - On January 4, 2023, a criminal information was filed in the Southern District of Illinois, in which Jet Medical Inc. (Jet), a medical device...more

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

ArentFox Schiff on 11/18/2022

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

7 Telehealth Red Flags – OIG Shares Measures for Spotting Medicare Fraud

Hendershot Cowart P.C. on 10/21/2022

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a report last month assessing the program integrity risks associated with Medicare telehealth services. After analyzing...more

Investigations Newsletter: OIG Warns That Proposed Drug Discounts May Warrant Sanctions

ArentFox Schiff on 10/10/2022

OIG Warns That Proposed Drug Discounts May Warrant Sanctions - On October 5, the US Department of Health and Human Services’ Office of Inspector General (OIG) issued an advisory opinion assessing a proposal that involved...more

[Virtual Event] Healthcare Enforcement Compliance Conference - November 7th - 9th, 8:55 am - 3:30 pm CST

Health Care Compliance Association (HCCA) on 9/1/2022

Hear directly from the enforcement community - Want to gain insight into properly monitoring, detecting, investigating, and managing violations? Join us virtually at HCCA’s Annual Healthcare Enforcement Compliance...more

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

ArentFox Schiff on 8/8/2022

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

HHS 2021 Semiannual Report to Congress Draws Attention to Genetic Testing, Durable Medical Equipment, and Opioid Disorder...

Venable LLP on 7/28/2022

On June 6, 2022, the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), released its spring 2022 semiannual report to Congress. The semiannual report covers the period of October 1, 2021 to...more

[Event] Regional Healthcare Compliance Conference - July 22nd, Seattle, WA

Health Care Compliance Association (HCCA) on 6/8/2022

Looking for compliance training and networking in your area? HCCA’s Regional Healthcare Compliance Conferences offer practitioners convenient, local compliance training, including updates on the latest news in regulatory...more

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