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Fraud Fraud and Abuse

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
NAVEX

How Healthcare Organizations Can Strengthen Compliance to Fight Fraud, Waste and Abuse

NAVEX on

Healthcare organizations face an ever-growing list of regulatory demands and risks, with Fraud, Waste, and Abuse (FWA) at the forefront. Addressing FWA is more than avoiding fines under regulations like the False Claims Act –...more

Rumberger | Kirk

How to Steer Clear of Employee Retention Credit Fraud

Rumberger | Kirk on

Orlando firms need to make sure they aren’t among the thousands of U.S. businesses that potentially were tricked by scams to inadvertently file fraudulent employee retention credit claims — something punishable by fines and...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

IRS Resumes Processing New Claims for Employee Retention Credit

After lifting the moratorium on processing tax refund claims, the Internal Revenue Service (IRS) has begun processing a large backlog of claims for the employee retention tax credit (ERC), aimed at businesses impacted by...more

Bass, Berry & Sims PLC

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

Bass, Berry & Sims PLC on

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

Sheppard Mullin Richter & Hampton LLP

HHS & DOJ FY 2022 Enforcement Targeted Fraud in COVID-19, Telemedicine, Opioid and Prescription Drugs, and Substance Use Treatment...

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released its “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022” (the “Report”), highlighting...more

Freiberger Haber LLP

Enforcement News: SEC Brings Enforcement Action in Connection EB-5 Immigrant Investor Program

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In July of this year, we wrote about a fraud action involving the EB-5 Immigrant Investor Program (“EB-5 Program” or “Program”) (here). Under the EB-5 Program, investors are eligible for permanent residency status in the U.S....more

Health Care Compliance Association (HCCA)

Final Rule Increases Fines for Grant Fraud, Codifies OIG Authority to Sanction Awardees

Report on Research Compliance Volume 20, no 8 (August 2023) With the publication of a rule finalizing financial penalties for grant fraud and related violations of U.S. law, the HHS Office of Inspector General (OIG) has a...more

Venable LLP

A Proposed New Regulatory Environment for Medicare Hospice Providers: Application of the 36-Month Rule, Increasing Enrollment...

Venable LLP on

On July 10, 2023, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that would (i) include hospices in the 36-month rule ownership transfer restrictions that currently exist for home...more

BCLP

Five years on: EKRA's legacy

BCLP on

Five years ago Congress enacted the Eliminating Kickbacks in Recovery Act of 2018 (“EKRA”). Aimed at combating kickbacks in the addiction treatment industry, EKRA prohibits remunerations in return for patient referrals to...more

Lippes Mathias LLP

The Curious World of Inspectors General

Lippes Mathias LLP on

One government agency type that has gathered increasing attention in the last several years is that of the Inspector General. Inspectors General are found at both the federal and state level. Some have broad-based powers...more

Robinson+Cole Health Law Diagnosis

Connecticut Expands Applicability of State False Claims Act

On June 26, 2023, Connecticut Governor Ned Lamont signed into law Public Act 23-129: “An Act Concerning Liability for False and Fraudulent Claims” (the Act). The Act expands application of Connecticut’s False Claims Act...more

Dechert LLP

Réforme des opérations transfrontalières en France

Dechert LLP on

Harmonisation du cadre juridique des opérations transfrontalières (fusions, scissions, apports partiels d'actifs, transformations) au sein de l'Union européenne. Renforcement de la protection des associés, créanciers et...more

Dechert LLP

Reform of Cross-Border Operations in France

Dechert LLP on

Harmonization of the legal framework for cross-border operations (mergers, spin-offs, partial contributions of assets, transformations) within the European Union. Strengthening the protection of shareholders, creditors,...more

Harris Beach PLLC

Updates Coming to OIG Compliance Program Guidance

Harris Beach PLLC on

The Department of Health and Human Services’ Office of Inspector General (“OIG”) willmodernize its Compliance Program Guidance (“CPG”) beginning at the end of calendar year 2023. The updates will be posted on the OIG website...more

Proskauer - Health Care Law Brief

Another Resolution by DOJ Pursuant to its Civil Cyber-Fraud Initiative Highlights Continued Efforts to Hold Companies Accountable...

We previously wrote about the United States Department of Justice’s (“DOJ”) Civil Cyber-Fraud Initiative (“CCFI”), which “aims to hold accountable entities or individuals that put U.S. information or systems at risk by...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

Health Care Compliance Association (HCCA)

Report on Research Compliance Volume 20, Number 3. - Hunter College Whistleblower: Suit Was to End ‘Luxury Vacations, Fraud...

Report on Research Compliance Volume 20, Number 3. February 23, 2023 - To those who say whistleblowers are only interested in the money a settlement can bring, meet Devin English. An assistant professor in the Department of...more

Sheppard Mullin Richter & Hampton LLP

Statute of Limitations for PPP and EIDL Fraud Extended to Ten Years

On August 5, President Biden signed two bills into law that extend to ten years the statute of limitations for civil and criminal enforcement actions for fraud on the Paycheck Protection Program (“PPP”) and Economic Injury...more

Wilson Sonsini Goodrich & Rosati

OIG Special Fraud Alert Lists Suspect Characteristics in Telemedicine and Telehealth Arrangements

Based on recent enforcement actions and increased scrutiny in telemedicine, the Office of Inspector General (OIG) recently published a Special Fraud Alert regarding fraud concerns in arrangements between healthcare...more

ArentFox Schiff

OIG Warns Health Care Practitioners About Fraud Schemes With Telemedicine Companies in Special Fraud Alert

ArentFox Schiff on

On July 20, 2022, the HHS Office of Inspector General (OIG) issued a Special Fraud Alert cautioning physicians and other health care practitioners to use “heightened scrutiny” when entering into telemedicine arrangements that...more

Miller Canfield

New Federal Anti-Fraud Guidance for Participants in the Telehealth Space

Miller Canfield on

On July 22, 2022, the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) issued a Special Fraud Alert regarding transactions between practitioners and telemedicine companies. Aware that...more

Proskauer - Health Care Law Brief

OIG Issues Special Fraud Alert Regarding Telemedicine Arrangements

On July 20, 2022, the Office of Inspector General for the Department of Health and Human Services (“OIG”) issued a special fraud alert (“Alert”) advising “practitioners to exercise caution when entering into arrangements with...more

Foley & Lardner LLP

OIG Special Fraud Alert on Arrangements with Telemedicine Companies

Foley & Lardner LLP on

On July 20, 2022, HHS-OIG published a new Special Fraud Alert on arrangements with telemedicine companies, setting forth seven characteristics OIG believes could suggest a given arrangement poses a heighted risk of fraud and...more

Sheppard Mullin Richter & Hampton LLP

OIG Issues Favorable Advisory Opinion for Physician-Owned Medical Device Company

On April 25, 2022, the Office of Inspector General (“OIG”) issued Advisory Opinion No. 22-07 which evaluated the risk of fraud and abuse under the federal anti-kickback statute (“AKS”) posed by an arrangement involving...more

J.S. Held

The Role of Forensic Accountants in Measuring and Detecting Fraud in Inventory Loss Claims

J.S. Held on

Insurance claims for loss of inventory are generally examined by insurance carriers. The carrier will retain a forensic accountant who has the ability to quantify out of sight inventory losses. Out of sight inventory losses...more

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