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Medicaid › Whistleblowers › Healthcare Fraud

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
ArentFox Schiff

Investigations Newsletter: US Supreme Court Declines to Consider AKS ‘Willfulness’ Question

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US Supreme Court Declines to Consider AKS ‘Willfulness’ Question - On October 7, the US Supreme Court denied a petition in which a whistleblower asked the Court to decide whether a “willful” act under the federal...more

ArentFox Schiff

Investigations Newsletter: Florida Lab Owner Agrees to Pay Over $27 Million to Resolve Three Whistleblower Lawsuits

ArentFox Schiff on

Florida Lab Owner Agrees to Pay Over $27 Million to Resolve Three Whistleblower Lawsuits - Daniel Hurt, the prior owner and operator of Fountain Health Services LLC, Verify Health, Landmark Diagnostics LLC, First Choice...more

Mandelbaum Barrett PC

Recent Amendments to the New Jersey False Claims Act

Mandelbaum Barrett PC on

Effective June 30, 2023, the New Jersey Legislature amended the New Jersey False Claims Act (“NJFCA” or “Act”) to align it more closely with the federal False Claims Act (‘FFCA”) and, thus, make New Jersey eligible for a 10%...more

Cozen O'Connor

Are You Secure? DOJ’s Cyber-Fraud Initiative and Heightened FCA Enforcement

Cozen O'Connor on

False Claims Act (FCA) enforcement has routinely targeted false information supplied to Medicare and Medicaid. A new trend in false-reporting cases is emerging under the FCA’s broad authority — cybersecurity enforcement....more

ArentFox Schiff

Investigations Newsletter: Clinical Laboratory and CEO To Pay Over $13 Million to Settle False Claims Act Allegations

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Clinical Laboratory and CEO To Pay Over $13 Million to Settle False Claims Act Allegations - A New Jersey-based laboratory, RDx Bioscience Inc. (RDX), and its owner and CEO, Eric Leykin, agreed to pay $10,315,023 to the US...more

Health Care Compliance Association (HCCA)

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

Health Care Compliance Association (HCCA) on

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

Clark Hill PLC

Healthcare Organizations and Practitioners Receive New Protection Against Frivolous Whistleblower Lawsuits

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Last Friday, the U.S. Supreme Court (SCOTUS) handed down an important ruling that will give healthcare organizations and practitioners relief against meritless whistleblower lawsuits. The ruling could result in saving...more

Rivkin Radler LLP

FCA Complaint Filed Against Interventional Radiologist

Rivkin Radler LLP on

On May 2, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced that the United States has filed a complaint under the False Claims Act (FCA) against James McGuckin, an interventional radiologist. The...more

Cozen O'Connor

Healthcare Provider Settles with Virginia AG for $3 Million to Resolve Fraudulent Medicare Billing Allegations

Cozen O'Connor on

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

Quarles & Brady LLP

Supreme Court to Review the Objective Scienter Standard Under the False Claims Act in U&C Drug Pricing Suits

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On January 13, 2023, the United States Supreme Court granted certiorari1 to review the False Claims Act (“FCA”) scienter standard in two FCA whistleblower cases from the Seventh Circuit, U.S. ex rel. Schutte v. SuperValu...more

Health Care Compliance Association (HCCA)

[Virtual Event] Healthcare Enforcement Compliance Conference - November 7th - 9th, 8:55 am - 3:30 pm CST

Health Care Compliance Association (HCCA) on

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

Mintz - Health Care Viewpoints

False Claims Act Settlements and Judgments Exceed $5.6 Billion in Fiscal Year 2021

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The Department of Justice announced in a February 1, 2022 press release (Press Release) that it obtained more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims in the fiscal year...more

Brownstein Hyatt Farber Schreck

State Lawmakers Introduce Colorado False Claims Act

Brownstein Hyatt Farber Schreck on

Within days of gaveling in the 2022 Colorado legislative session, a coalition of state leaders introduced a bill to create the Colorado False Claims Act (the “CFCA”). The brainchild of Attorney General Phil Weiser, the CFCA...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

The Empire State Strikes Back at Medicaid Fraud: $216M Recovered Under New York's False Claims Act Over Three-Year Period

Pietragallo Gordon Alfano Bosick & Raspanti,... on

Takeaway: From 2018 to 2020, the New York False Claims Act yielded an impressive $216,936,354 in recoveries and returned $130,161,812 to New York State’s Medicaid Program....more

Pietragallo Gordon Alfano Bosick & Raspanti,...

The New Jersey False Claims Act: A Decade Of Data Reveal $147m Recovered By The Garden State

Pietragallo Gordon Alfano Bosick & Raspanti,... on

Takeaway: Based on data reported by the State Attorney General, New Jersey’s False Claims Act (NJFCA) has been a legislative success. Between 2010 and 2019, the State netted $147 million under the NJFCA, while relators...more

Health Care Compliance Association (HCCA)

[Event] 2022 Managed Care Compliance Conference - January 30th - February 1st, Phoenix, AZ

Health Care Compliance Association (HCCA) on

Attend our annual event for those who manage compliance at health plan providers. Explore topics and issues that are pertinent to industry professionals like you. Learn the latest practices, share strategies, and connect with...more

ArentFox Schiff

Investigations Newsletter: Court Rules Prescription Drug Event and Enrollee Encounter Data Are 'Claims for Payment' Under the...

ArentFox Schiff on

Court Rules Prescription Drug Event and Enrollee Encounter Data Are 'Claims for Payment' Under the False Claims Act - US District Judge Noel L. Hillman approved a whistleblower’s request to file a Fourth Amended Complaint...more

Polsinelli

Retaliation Against a Former Employee Can Give Rise to a False Claims Act Retaliation Claim

Polsinelli on

On March 31, 2021, in United States ex rel. Felten v. William Beaumont Hospital, the Sixth Circuit Court of Appeals held that an employer’s allegedly retaliatory conduct directed at an employee after the employee’s...more

Brooks Pierce

Owner And Managers Of Health Care Practice Pay $900,000 To Resolve False Claims Act Lawsuit

Brooks Pierce on

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

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 2. News Briefs: January 2020 #2

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 29, no. 2 (January 20, 2020) - - The HHS Office of Inspector General has updated its Work Plan, which includes an item on early discharges from inpatient rehabilitation facilities to home...more

Baker Donelson

False Claims Act Liability Without Submitting False Claims? Yes, That's a Thing

Baker Donelson on

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

K&L Gates LLP

The False Claims Act & Health Care: 2018 Recoveries and 2019 Outlook

K&L Gates LLP on

In 2018, the False Claims Act (“FCA”) continued to be one of the federal government’s (“Government”) preferred civil fraud enforcement tools across a variety of industries. The healthcare industry, however, remained the...more

The Volkov Law Group

Focusing on “Payments” to Healthcare Professionals (Part I of III)

The Volkov Law Group on

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

Bradley Arant Boult Cummings LLP

False Claims Act Suits Relied Heavily on Whistleblowers in 2018

Bradley Arant Boult Cummings LLP on

Companies that work with the federal government (think Medicare and Medicaid reimbursements, government contracts, grant funding) need to stay up to date on the False Claims Act (FCA). The FCA is one of the primary tools used...more

Burr & Forman

The Causation Trend in Anti-Kickback False Claim Cases: Courts’ Rejection of Relators’ Taint Theory Should “Cause” Them Concern at...

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The False Claims Act (“FCA”) permits a person, known as a “qui tam relator” (or more commonly, a “whistleblower”), to bring a lawsuit on behalf of the federal government when that person has information that a healthcare...more

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