The Department of Justice made a major announcement last week that demonstrates that it is serious about finding those who defraud various COVID-19 relief programs and holding them accountable to the fullest extent of the law. Over the course of the last three months alone, working in concert with numerous law enforcement partners, including the … Continue Reading
Earlier this month, the Supreme Court of the United States decided Dubin v. United States, No. 22-10, 2023 WL 3872518, at *1 (U.S. June 8, 2023), in favor of the defendant. Justice Sonia Sotomayor wrote the opinion for the Court, which held that 18 U.S.C. § 1028A(a)(1), aggravated identity theft, is violated only when the … Continue Reading
Earlier this year, we previewed two significant False Claims Act (FCA) cases before the U.S. Supreme Court, United States ex. rel. Schutte v. SuperValu, Inc., No. 21-1326 (“SuperValu”), and United States ex. Rel. Proctor v. Safeway, Inc., No. 22-111 (“Safeway”). The FCA provides that “any person who knowingly presents, or causes to be presented, a … Continue Reading
The Supreme Court recently heard oral argument in the appeal of two False Claims Act (FCA) cases from the Seventh Circuit that called into question the level of intent, or scienter, required to establish corporate liability under the FCA for “knowingly” overbilling the government for goods or services. The Court’s eventual decision may have widespread … Continue Reading
Last week, the Sixth Circuit issued an important decision limiting the scope of claims alleging violations of the Anti-Kickback Statute that are brought under the False Claims Act. See Shannon Martin, M.D., et al. v. Hathaway, et al., No. 22-1463 (March 28, 2023). Chief Judge Sutton wrote the opinion for the Court, which Judge Siler … Continue Reading
There has been no shortage of news this month, so it is understandable that a major presidential proposal garnered relatively little attention at the time. On March 2, the President proposed a sweeping pandemic anti-fraud initiative that is designed to give key oversight bodies additional tools to investigate and prosecute those who defraud the pandemic … Continue Reading
The Department of Justice (“DOJ”) recently announced its largest ever health care fraud and opioid enforcement action. In a coordinated effort, DOJ charged 345 defendants with more than $6 billion in fraud losses for submitting false and fraudulent claims to federal health care programs and private insurers.… Continue Reading
In remarks to the Association of Certified Anti-Money Laundering Specialists (“ACAMS”), Kenneth A. Blanco, the Director of the U.S. Treasury’s Financial Crimes Enforcement Network (“FinCEN”), covered a number of high-priority topics, including FinCEN’s response to the pandemic, the latest COVID-19 related fraud schemes, emerging cyber threats, virtual currency issues, and important regulatory updates. A theme … Continue Reading
Release of $4.9 billion in financial assistance for nursing homes, which care for high risk seniors, is not all good news. Already facing difficult times, skilled nursing facilities will receive even more scrutiny to account for the money. Read tips here from former prosecutors Marisa Darden, David Maria, and Tom Zeno.… Continue Reading
Although the rapid shift to telehealth is a boon to providers and patients, the federal government has issued specific guidance that providers need to follow. See tips for compliance provided by David Maria, a former federal prosecutor and member of the Department of Justice Medicare Fraud Strike Force, and Trevor Garmey, a Senior Associate with … Continue Reading
The Department of Justice (DOJ) recently intervened in a False Claims Act (FCA) lawsuit involving allegations of kickbacks for prescription drug copays. The DOJ says the lawsuit makes “clear that the Department will hold accountable drug companies that pay illegal kickbacks to facilitate increased drug prices.” The DOJ “will not allow drug companies to use … Continue Reading
In 2018, the US Department of Justice (DOJ) issued many important policy updates and rollouts that will have far-reaching impact. Our firm’s Alert provides an easily navigated yet detailed summary of developments. Policy Shifts at the Department of Justice – 2018 in Review focuses on government investigations and white collar prosecutions. The Alert covers:… Continue Reading
The federal government’s recoveries for false claims during FY2018 topped $2.8 billion. The Department of Justice (DOJ) recently released this and other statistics for its civil False Claims Act recoveries since 1986. Although the most numerous and lucrative recoveries occurred in the health care industry, the DOJ reported 35 new qui tam cases involving the Department … Continue Reading
On October 26, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that will, among other initiatives, allow CMS to recover higher dollar amounts of improper payments made to Medicare Advantage. To read more about this ruling and what it might mean for you, click here to read a recent Squire Patton … Continue Reading
Third Circuit Clarifies Public Disclosure Bar in False Claims Act In United States v. Omnicare, Inc., the Third Circuit clarified the operation of the public disclosure bar in the False Claims Act (FCA). The court held that publicly available information “could not have reasonably or plausibly supported an inference” of fraud. This information included government … Continue Reading
At the end of June, Attorney General Sessions revealed the largest number of defendants ever charged for healthcare fraud. Read here for a summary of the number of individuals, the types of charges, and the agencies involved.… Continue Reading
Government uses data mining to select targets for enforcement actions. Your company can use data mining for compliance. Hear tips and insights in an eleven minute podcast in “Compliance Perspectives,” from the Society of Corporate Compliance and Ethics (SCCE). SCCE is a member-based association providing education and news updates for ethics and compliance professionals. To listen to the podcast, click here.… Continue Reading
Even a misdemeanor guilty plea can have far reaching ramifications in the healthcare industry. The Sixth Circuit recently upheld a decision of the Department of Health and Human Services (HHS) that a healthcare provider was subject to mandatory exclusion following a guilty plea to misdemeanor misbranding. As the court recognized, trial counsel had anticipated this … Continue Reading
June 16, 2017, marks the one-year anniversary of the precedent-setting U.S. Supreme Court decision in Universal Health Services v. United States ex rel. Escobar (Escobar), which approved the implied false certification theory as a basis for liability under the False Claims Act (FCA). Because the decision impacts every provider who supplies goods and services to … Continue Reading
