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Health Care Providers False Statements

Lathrop GPM

Fighting the Robots: Texas Attorney General Settles “First-of-its-Kind” Investigation of Healthcare AI Company

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In what it describes as a “First-of-its-Kind Healthcare Generative AI Investigation”, the Texas Attorney General (AGO) recently reached a settlement agreement with an artificial intelligence (AI) healthcare technology...more

Quarles & Brady LLP

Texas Attorney General Obtains Settlement of Alleged False and Misleading Statements About Healthcare Artificial Intelligence...

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On September 18, 2024, the Attorney General (AG) of Texas announced a settlement with an artificial intelligence-focused healthcare technology company to resolve allegations of false and misleading statements about the...more

McDermott Will & Emery

FDA Gives Companies a New Way to Fight Misinformation

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Misinformation shared by independent third parties presents a significant public health concern because it can lead patients and healthcare providers to forgo treatments that are safe and effective or choose treatments that...more

Health Care Compliance Association (HCCA)

‘If Only She Could Have Been Stronger’: Miami Trial Fraud Leads to Prison, Personal Loss

In September 2015, while working in an office on the grounds of Mercy Hospital in Miami, Ivette Maria Portela Martinez learned about an upcoming clinical trial for treatment of symptoms of Clostridium difficile infections and...more

Harris Beach PLLC

OIG January 2024 Enforcement Summary

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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

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | March 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for March 2023. We discuss several criminal and civil enforcement actions that involve Anti-Kickback Statute (AKS) and...more

Rivkin Radler LLP

Spinal Device Distributor, Owners and PODs Settle Kickback Claims for $1 Million

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The U.S. Department of Justice (DOJ) recently announced that Reliance Medical Systems LLC, a Utah-based distributor of spinal implant devices, two of its individual owners, and two of its physician-owned distributorships...more

Health Care Compliance Association (HCCA)

Report on Research Compliance Volume 18, Number 10. In This Month’s E-News: October 2021

Report on Research Compliance 18, no. 10 (October, 2021) - An audit by the HHS Office of Inspector General (OIG) of the National Human Genome Research Institute’s (NHGRI) pre-award risk assessment process concluded that...more

Roetzel & Andress

Negative Online Reviews and Reputation Management: Tips for Health Care Practices and Providers

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More patients than ever admit to choosing their health care providers based on what they read online. This means that false and misleading reviews which appear online can significantly impact a health care provider’s...more

K&L Gates LLP

Qui Tam Quarterly: Strategies for Avoiding the "Battle of the Experts" in False Claims Act Cases Based on Medical Necessity

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Medical necessity cases continue to be a focal point for False Claims Act (FCA) investigations and lawsuits. With this focus comes an age-old problem for health care providers and entities defending these actions: the...more

Butler Snow LLP

Pro Te: Solutio – Vol. 12, No. 3

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Summer is winding down, and Fall texted to say she is on her way. This means that Pro Te: Solutio is returning for its third edition of 2019. As always, our authors have taken the time to research and address current issues...more

Foley & Lardner LLP

The Ninth Circuit Expected to Rule that Doctors Can Be Wrong in the Winter v. Gardens False Claims Act Case

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On September 13, 2019, the Ninth Circuit heard oral argument in the False Claims Act Case of Winter v. Gardens (18-55020). The government, as an amicus in the case, carried the bulk of the argument on behalf of the plaintiff...more

McDermott Will & Emery

Eighth Circuit Rejects FCA Claim for Failure to Allege Actual Claims for Payment

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On February 11, 2019, the Eighth Circuit affirmed the dismissal of a group of relators’ qui tam suit against Crawford County Memorial Hospital for failure to meet the pleading standards required by Federal Rule of Civil...more

McDermott Will & Emery

Questions Remain for the EHR Industry as a Second EHR Vendor, Greenway Health, Settles False Claims Act Allegations

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On February 6, 2019, the DOJ announced a settlement agreement with Greenway Health, a vendor of EHR software, under which Greenway agreed to pay approximately $57 million to resolve allegations that it caused its health care...more

Baker Donelson

New Tennessee Law Targets Marketing and Referrals by Alcohol and Drug Abuse Treatment Providers

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The growing concern over opioid abuse has prompted both the federal government and many states to address concerns over referrals for substance abuse treatment. Tennessee recently addressed the issue in House Bill No. 2068,...more

Saul Ewing LLP

Sixth and Tenth Circuits Rule that Medical Statements Are Capable of Falsehood Under the FCA

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Two recent False Claims Act (FCA) decisions – United States v. Paulus, 894 F.3d 267 (6th Cir. 2018) and United States ex rel. Polukoff v. St. Mark’s Hospital, 895 F.3d 730 (10th Cir. 2018) – establish that an FCA claim can be...more

Bass, Berry & Sims PLC

FCA Medical Necessity Cases May Stand on Firmer Footing After Recent Appellate Decisions

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In recent years, healthcare providers have increasingly faced civil and criminal enforcement actions premised on the allegation that services billed to government healthcare programs were not medically necessary. As a result,...more

Mintz - Health Care Viewpoints

Tenth Circuit Revives FCA Claim Based on Alleged Lack of Medical Necessity

The Tenth Circuit Court of Appeals has issued a significant decision, finding that a physician’s medical judgment about the medical necessity of heart procedures can be “false or fraudulent” under the federal False Claims Act...more

Holland & Knight LLP

Healthcare Law Update: September 2017

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OIG Advisory Opinions - Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized - On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more

Pillsbury Winthrop Shaw Pittman LLP

A “Change of Heart” in a Health Care Fraud Prosecution - Inconsistent angiogram interpretations establish reasonable doubt in...

On March 7, 2017, the U.S. District Court for the Eastern District of Kentucky reversed the October 27, 2016 criminal jury verdict against Kentucky cardiologist Dr. Richard E. Paulus, and acquitted him on all counts of health...more

Bradley Arant Boult Cummings LLP

OIG Expands Exclusionary Authority

The Department of Health and Human Services, Office of Inspector General (OIG) published a final rule on January 12, 2017, expanding the OIG’s authority to exclude providers from participation in federal healthcare programs....more

Baker Donelson

Operative Reports May Lead to False Statement Prosecution

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You are a hardworking surgeon who is committed to providing quality care to all of your patients, including your Medicare beneficiaries. Because you are so busy, you routinely dictate your pre-operative and post-operative...more

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