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Department of Justice (DOJ) Fraud and Abuse Centers for Medicare & Medicaid Services (CMS)

Gardner Law

[Hybrid Event] “Steer” Clear of Legal Lassos: Readiness Strategies for FDA-Regulated Companies - May 1st, Austin, TX

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Join Gardner Law for a half-day CLE event in person at the Capital Factory in Austin, TX or attend virtually. Prepare for the regulatory rodeo with confidence by learning how to navigate regulatory, compliance, and privacy...more

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...more

McDermott Will & Emery

Healthcare Regulatory Check-Up Newsletter | November 2023 Recap

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This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for November 2023. We discuss several US Department of Health and Human Services (HHS) agency actions, including the new General...more

Bass, Berry & Sims PLC

HHS Releases Groundbreaking General Compliance Program Guidance, Setting New Standards for Healthcare Entities

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On November 6, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released the most up-to-date, comprehensive, and practical general compliance guidance in decades. The new...more

Health Care Compliance Association (HCCA)

[Event] 2023 Healthcare Enforcement Compliance Conference - November 5th - 7th, Washington, DC

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

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | June 2023 Recap

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This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for June 2023. We discuss several civil enforcement actions involving false claims, the Anti-Kickback Statute (AKS) and...more

Kohn, Kohn & Colapinto LLP

The Government’s Ability to Combat Fraud is on the Line in False Claims Act Supreme Court Case

Oral arguments are scheduled for April 18, 2023, in the Supreme Court case combining two Seventh Circuit Court of Appeals cases U.S. ex rel. Schutte v. SuperValu, Inc. (“SuperValu”) and U.S. ex rel. Thomas Proctor v. Safeway,...more

Verrill

The PHE is Ending: Do You Know Where Your Waivers Are?

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While the pandemic is not over, the COVID-19 public health emergency (PHE) is expected to expire soon, which means that a number of operational, safety, and billing standards that were waived at the beginning of the pandemic...more

Dickinson Wright

Telehealth Update: Telehealth Waivers Post-PHE and Fraud and Abuse

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The current Public Health Emergency expiration deadline is this month. However, the Secretary of the Health and Human Services indicated he would provide a 60-day notice before ending the PHE in order to minimize disruptions...more

King & Spalding

DOJ and HHS Issue Healthcare Fraud and Abuse Control Program Fiscal Year 2021 Report

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Last week, DOJ and HHS-OIG published its annual report regarding the Healthcare Fraud and Abuse Control (HFAC) Program (the Report). The Report summarizes the enforcement activity of DOJ and HHS and states that during Fiscal...more

Health Care Compliance Association (HCCA)

Health Care Fraud and Abuse Control Program FY 2021 Report

The recently-released Health Care Fraud and Abuse Control Program FY 2021 report contains a treasure trove of information for healthcare compliance teams. To gain a better understanding of lessons to be learned from this...more

Tucker Arensberg, P.C.

2022 Federal Compliance Enforcement Outlook

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There is almost universal agreement regarding predictions for 2022 federal enforcement in the following areas: ..The use of fraudulently obtained COVID relief funds in both healthcare and in general, but specifically as...more

Jones Day

DOJ Ramps Up Coordinated Law Enforcement Action to Combat Health Care Fraud Related to COVID-19

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On May 26, 2021, DOJ announced a series of coordinated law enforcement actions against 14 defendants across seven federal districts for alleged participation in fraudulent health care schemes that, according to the...more

Tucker Arensberg, P.C.

Medical Practices Face Liability for COVID Accelerated and Advance Payments and PPP Loans

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Medical practices are now beginning to encounter Medicare payment claw backs by CMS for COVID Accelerated and Advanced Payments (CAAP) and Department of Justice (DOJ) prosecution for Paycheck Protection Program (PPP) abuses. ...more

Troutman Pepper

Anti-Kickback Statute Enforcement Year in Review and Outlook for 2021

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I. Introduction - While 2020 was a year like no other in many ways, the challenges posed by the global COVID-19 pandemic do not appear to have stalled the Department of Justice’s (DOJ) health care fraud enforcement...more

Troutman Pepper

Fraud Emerges as Telemedicine Surges: Compliance Guidance for Telemedicine Providers

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Telemedicine providers – whether they are established or new to the space – should examine the type of conduct DOJ has recently focused on and adapt their compliance systems accordingly. Providers should also consider the...more

Miles & Stockbridge P.C.

National Criminal Takedown of Health Care Professionals

The Department of Justice recently announced the results of its 2020 National Health Care Fraud and Opioid Takedown. This annual DOJ tradition, aimed at targeting and arresting individuals for health care fraud abuse,...more

ArentFox Schiff

Investigations Newsletter: SDNY Files Civil Fraud Lawsuit Against Anthem

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SDNY Files Civil Fraud Lawsuit Against Anthem - On March 27, 2020, the Manhattan U.S Attorney announced the filing of a civil fraud lawsuit against Anthem Inc. for allegedly falsely certifying the accuracy of diagnosis...more

Hogan Lovells

FCA Alert: Decision Opens Door to Challenge of Agency Guidance in False Claims Cases

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On November 5, 2019, the United States District Court for the Eastern District of Pennsylvania ruled on a motion to dismiss a False Claims Act (FCA) qui tam suit filed by the United States Department of Justice, long after it...more

McDermott Will & Emery

Healthcare Enforcement Quarterly Roundup | Q2 2019

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In this second installment of the Healthcare Enforcement Quarterly Roundup for 2019, we cover several topics that have persisted over the past few years and identify new issues that will shape the scope of enforcement efforts...more

BCLP

Telemedicine Fraud Quagmire

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A recent telemedicine fraud case from the United States Department of Justice highlights the ongoing legal quagmires that healthcare companies are facing when implementing new digital health ventures. Specifically, the...more

Wilson Sonsini Goodrich & Rosati

DOJ Takes Down $1.2 Billion Healthcare Fraud Scheme Involving Telemedicine, DME Companies, and Medical Professionals

On April 9, 2019, the Department of Justice (DOJ), working with multiple departments and agencies, including the U.S. Department of Health and Human Services—Office of the Inspector General (HHS-OIG), brought enforcement...more

Epstein Becker & Green

Healthcare Fraud Prevention Partnership Issues a Review of Clinical Laboratory Services

The Healthcare Fraud Prevention Partnership (“HFPP”) recently published its second white paper, entitled “Examining Clinical Laboratory Services,” which provides a comprehensive overview of practices that raise fraud and...more

Bass, Berry & Sims PLC

Healthcare Fraud & Abuse Review 2017

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A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Baker Donelson

Health Care Fraud Prosecutions: Strong Seas and High Winds Ahead for Individuals and Corporations

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During the past nine months, the U.S. Department of Justice (DOJ) has made several significant policy pronouncements that impact health care organizations and individual providers. These directives and initiatives reflect...more

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