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False Claims Act Insights - Are All Healthcare “Kickbacks” Subject to FCA Liability?
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Episode 303 --- Deep Dive into the HHS-OIG Compliance Program Guidance
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Health Care Fraud and Abuse Control Program FY 2021 Report
Proof in Trial: Appellate Edition: Integra Med Analytics LLC et al. v. Providence Health & Services et al.
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Staying Prepared: Hospices and the False Claims Act, Part III - Success in False Claims Act Lawsuits
Healthcare Headlines Episode 3 - Stay Ready: Trends in Healthcare False Claims Act Investigations
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To prove a False Claim under the False Claims Act (FCA), the government or relator must establish three elements: 1.Falsity; - 2.Knowledge; and - 3.Materiality. In this blog post, we will explore the Falsity element. ...more
The U.S. Attorney’s Office for the Eastern District of Michigan announced on May 8 that Michigan Ear Care PLLC and James Aronovitz, D.O. agreed to pay over $2 million to resolve allegations that they submitted false claims to...more
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
On December 19, Michael Lonski, a Greenwich psychologist, was sentenced to a 27-month prison term and three more years of supervised release for a scheme to defraud Medicaid. Lonski submitted over 80,000 claims from 2014 to...more
On December 14, the U.S. Attorney’s Office for the Southern District of New York and other agencies announced the indictment of Niranjan Mittal, a Brooklyn cardiologist, on multiple fraud charges. Mittal allegedly fabricated...more
Cosmetic surgeries are on the rise. One study of cosmetic surgery data found that body procedures like tummy tucks, buttock augmentation, and liposuction increased by 63 percent from 2020 to 2021. Facelifts were up 54...more
Virginia AG Jason Miyares reached a settlement with 1st Adult & Pediatrics Healthcare Services, Inc. to resolve allegations that the company violated the False Claims Act by submitting fraudulent billing to Virginia’s...more
Transportation fraud isn’t new, but it’s new to Rivkin Rounds. The U.S. Attorney’s Office for the Southern District of New York recently announced that Yonkers resident Julio Alvarado was sentenced to 95 months in prison for...more
An audit by the New Jersey Office of the State Comptroller (OSC) found that John Gore, a licensed drug and alcohol counselor, improperly billed and received over $1 million in Medicaid payments for services provided between...more
Indiana AG Todd Rokita reached a settlement with pharmacy benefit manager (PBM) Centene Corporation and its subsidiaries (collectively, “Centene”) in connection with alleged overcharges by Centene to Indiana’s Medicaid...more
The U.S. Attorney’s Office for the District of Connecticut announced on November 3 that Ananthakumar Thillainathan, a physician with offices in Stratford and Milford, pleaded guilty to healthcare fraud and federal kickback...more
Physicians Group Services, P.A. (PGS) has reached a settlement with the U.S. and Florida to resolve allegations that it submitted false or fraudulent claims to the Florida Medicaid Program....more
The Justice Department is continuing to use criminal enforcement as an important tool in the fight against healthcare fraud. While the False Claims Act continues its important place in the fight against healthcare fraud, DOJ...more
Volumes have been written about the False Claims Act as a tool to pursue fraud against the government in circumstances where the defendant has allegedly made false statements to receive money from the government. For...more
Can a 40-year-old fraud and abuse law that compared to many others is relatively straightforward still get providers into trouble? Answer: You bet! In fact, in the first quarter of 2022 alone, the U.S. Attorney for the...more
Lab Owner Indicted For $100 Million Health Care Fraud Scheme - On November 2, 2021, a federal grand jury in the Western District of Arkansas indicted Billy Joe Taylor of Arkansas for an alleged health care fraud scheme. ...more
The owner of Brooklyn Chemists in Gravesend, Brooklyn and Lucky Care Pharmacy in Flushing, Queens was recently indicted on charges of conspiracy to commit health care fraud, conspiracy to defraud the United States by paying...more
On Sept. 9, 2020, the United States Attorney for the Western District of North Carolina announced that it had settled a whistleblower lawsuit alleging False Claims Act violations by two former managers and the owner of a now...more
DOJ announced a False Claims Act settlement with Universal Health (“UHS”) and related companies for $122 million for billing for medically unnecessary inpatient behavioral health services, failing to provide adequate services...more
The Situation: A jury had originally handed down a large verdict in a False Claims Act ("FCA") case that resulted in $347 million judgment. The district court threw out that verdict, however, and the relators appealed. The...more
Most health care providers recognize that submitting a knowingly false claim to a federally funded health care program violates the False Claims Act (FCA). However, it is less well known that indirectly "causing" someone else...more
The United States healthcare industry poses an infinite number of risks when it comes to interactions with healthcare professionals. Given the aggressive regulation and enforcement of prohibitions against kickbacks and...more
Despite the controversial impact of the Supreme Court’s Escobar decision, the Justice Department’s False Claims Act prosecutions and settlements are continuing at a consistent rate – heading towards another multi-billion...more