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Healthcare Department of Justice (DOJ) Health Insurance

Foley & Lardner LLP

Health Care Enforcement: “Tea Leaves” in the 2024 National Health Care Fraud Summer Takedown

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Each summer in recent years, the U.S. Department of Justice (DOJ) and associated fraud enforcement partners have indicted many health care defendants, in multiple cases across the country. This summer continued the tradition....more

Robinson+Cole Health Law Diagnosis

DOJ Charges 36 Defendants in Connection with Telemedicine and Clinical Laboratory Fraud and Abuse Schemes

On June 27, 2024, the Department of Justice (DOJ) announced its 2024 National Health Care Fraud Enforcement Action, which resulted in criminal charges against 193 defendants for alleged participation in various health care...more

Quarles & Brady LLP

DOJ Enforcement:  Urine Drug Testing

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On April 11, 2024, a jury convicted Northern Kentucky Center for Pain Clinic owner Dr. Timothy Ehn (who was not a medical doctor) and medical director, Dr. William Lawrence Seifert, for their roles in a scheme that defrauded...more

ArentFox Schiff

Fast Five: Important Law and Policy Updates for US Health Care Transactions

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With the end of the first quarter of 2024, we highlight five developments, changes, or challenges that health systems, hospitals, nursing homes, clinics, physician practices, health insurers, and other health care providers,...more

Dentons

DOJ Reports Record False Claims Act Settlements & Judgments in FY 2023

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Fiscal year 2023 saw record recoveries and the highest number of settlements and judgments ever under the Federal False Claims Act. According to a new report released by the United States Department of Justice (“DOJ”), the...more

Epstein Becker & Green

Rare DOJ Criminal Indictment Related to Medicare Advantage Risk Adjustment

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In an indictment announced on October 26, 2023 in Miami, the U.S. Department of Justice, Criminal Division’s Fraud Section, working with the FBI and HHS-OIG, brought what may be only the second federal criminal charges...more

Manatt, Phelps & Phillips, LLP

Access to Care for Justice-Involved Pregnant People With a Substance Use Disorder

There is a critical need to increase access to evidence-based care for justice-involved pregnant people with a substance use disorder (SUD)—and connect them to continued coverage and care upon release—according to national...more

Carlton Fields

7th Cir. Holds Insurance Coverage Applies to Settlement Payments for Alleged Anti-Kickback and False Claims Act Violations

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On May 3, 2023, the Seventh Circuit Court of Appeals, in Astellas US Holding Inc. v. Federal Insurance Co., held that a liability insurer was required to contribute its limits toward its insured’s payment to settle potential...more

Sheppard Mullin Richter & Hampton LLP

Navigating the Wild West of the New ACA Preventative Care Ruling

On March 30, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas issued a decision in Braidwood Management Inc. v. Becerra (“Braidwood”), invalidating the Affordable Care Act’s (“ACA’s”) mandate...more

Akerman LLP

False Claims Act 2022 in Review

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The U.S. government continued to earn its longstanding reputation for its vigorous enforcement of the False Claims Act (FCA) in 2022, either directly or through relator proxies. The Department of Justice (DOJ) recorded the...more

Polsinelli

DOJ Continues to Target Lab Sales Arrangements and Ordering Practices

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Signaling its continued scrutiny of the laboratory industry, the Department of Justice (DOJ) entered into a settlement agreement with Texas lab Genotox Laboratories Ltd. last month related to compensation Genotox paid to...more

Health Care Compliance Association (HCCA)

Florida Web Designer Settles with DOJ on 2020 HealthyKids.org Medicaid Breach

A Florida communications firm and its owner agreed to pay $293,771 to resolve False Claims Act (FCA) allegations that they failed to secure personal information on a federally funded Florida children’s health insurance...more

Polsinelli

Nursing Home Providers Suffer Blow as District Court Denies Motion to Dismiss in “Worthless Services” FCA Action Based on...

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On March 31, 2023, the United States District Court for the Eastern District of Pennsylvania dealt a blow to a trio of nursing home providers by denying their motion to dismiss a False Claims Act (FCA) claim brought by the...more

Akerman LLP - Health Law Rx

The Trebling Effect of (Some) False Claims Act Trials

There are multiple components to the risk defendants must consider when faced with going to trial for a matter involving the False Claims Act (FCA). Setting aside the incalculable impact that litigation can have on business...more

Polsinelli

Ten Individuals Charged in Business Email Compromise Scheme Targeting Medicare, Medicaid and Other Insurers

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On November 18, 2022, the U.S. Department of Justice (“DOJ”) announced charges against ten defendants across Georgia, South Carolina and Virginia, resulting from a scheme that allegedly targeted Medicare, state Medicaid...more

The Volkov Law Group

Modernizing Medicine Settles False Claims Act Violations for $45 Million

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The Justice Department continues to pile up healthcare enforcement actions — false claims, anti-kickback, and fraud.  DOJ is on its way to a record year....more

Jones Day

DOJ Announces Second-Largest Annual Total Recoveries in False Claims Act History

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DOJ recovers a record $5.6 billion from FCA cases in 2021, the largest annual total since 2014. - The United States Department of Justice Civil Division ("DOJ") recently announced a recovery of more than $5.6 billion in...more

Snell & Wilmer

What is the Fate of ACA? No Answers Yet from the Fifth Circuit.

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Background - As noted in our previous December 2018 blog post, “Texas Judge Declares the Affordable Care Act Unconstitutional – What’s Next?,” and our October 2019 newsletter, “2019 End of Year Plan Sponsor “To Do” List...more

McDermott Will & Emery

Antitrust Litigation Update for Health Care Providers - June 2019

2018 saw a significant upswing in antitrust litigation against health care providers; 27 cases were filed in 2018 versus 17 in 2017. In the latest Antitrust Update for Health Care Providers, we discuss what caused the notable...more

Sheppard Mullin Richter & Hampton LLP

Update to Texas v. United States

In our December blog post, we discussed Texas v. United States, No. 19-10011 (5th Cir.), a Texas federal district court decision which struck down the entirety of the Affordable Care Act (“ACA”). The case is being appealed to...more

Snell & Wilmer

Texas Judge Declares the Affordable Care Act Unconstitutional – What’s Next?

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As reported in our “2018 End of Year Plan Sponsor “To Do” List (Part 1) Health & Welfare,” the Tax Cuts and Jobs Act repealed the individual mandate, which spawned a lawsuit challenging the whole of the Affordable Care Act...more

Epstein Becker & Green

Is the Affordable Care Act a House of Cards? If Yes, What Does the Recent Texas Court Decision Mean for the US Health Insurance...

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In an unexpectedly broad ruling issued December 14, 2018, the U.S. District Court for the Northern District of Texas declared the Affordable Care Act (“ACA”) as unconstitutional in its entirety. This decision, if ultimately...more

Mintz - Health Care Viewpoints

What's Next After the Texas vs. Azar Ruling?

On Friday, December 14th, Judge Reed O’Connor, a Texas Federal District Court Judge, ruled on the case Texas vs. Azar. As background, Texas vs. Azar was filed by 20 Republican state attorneys general and governors. The...more

Mintz - Health Care Viewpoints

DOJ Announces Roundtable Series on Competition and Deregulation

The Department of Justice (“DOJ”) Antitrust Division recently announced plans to hold a series of public roundtable discussions to analyze the relationship between competition and regulation, and its implications for...more

Pierce Atwood LLP

Aetna-Humana Merger Blocked

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The District of Columbia federal court recently ruled that a proposed $37 billion merger between health insurance giants Aetna and Humana cannot proceed, granting the US Department of Justice’s bid to block the combination on...more

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