On October 21, 2019, U.S. District Judge Rosemary M. Collyer denied the government’s request to modify the Court’s previous ruling on September 17, 2019, that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority when it reduced
This week, the Department of Justice (DOJ) intervened in a False Claims Act (FCA) lawsuit against Life Spine and two of its executives, filed in the U.S. District Court for the Southern District of New York. The lawsuit alleges that Life Spine violated the Anti-Kickback Statute by paying more than $7 million in consulting fees, royalties, and intellectual property acquisition fees to surgeons to induce them to use Life Spine products in spinal surgeries. According to the complaint, the payment of these illegal kickbacks caused the submission of false claims to federal healthcare programs, including Medicare and Medicaid, under the theory that any claim for payment submitted in connection with an illegal kickback is “false” within the meaning of the FCA.
The Office of Inspector General (OIG) has added a new entity, Ridgeview Rehab & Nursing Center, LLC (Ridgeview), to its list of individuals and entities designated as “high risk – heightened scrutiny.” The “high risk – heightened scrutiny” list is part of the OIG’s fraud risk indicator tool, which the OIG made public last year. The fraud risk indicator tool places parties that have settled False Claims Act (FCA) allegations with the government into one of five categories on a risk spectrum.
Recently, the Office of Inspector General (OIG) published newly-issued guidance on the HHS OIG Grant Self-Disclosure Program (“Program”), which creates a formal framework for recipients, sub-recipients, and applicants for federal grant money to disclose potential violations of federal criminal, civil, or administrative law that may impact federally-awarded grants. Similar to the OIG’s Provider Self-Disclosure Protocol, the program offers incentives for self-disclosures in the form of reduced penalties and sanctions. The Program will be particularly important for individuals and entities, such as research universities, that receive federally-funded grants, as the Program establishes a specific process for making certain mandatory disclosures already required by law as well as provides guidance and incentives for making voluntary disclosures.
On May 13, the U.S. Supreme Court unanimously affirmed a decision by the U.S. Court of Appeals for the 11th Circuit, holding that the False Claims Act’s (“FCA”) limitations period in 31 U.S.C.(b)(2) applies to “relator-initiated actions” in which
On May 7, the Department of Justice (“DOJ”) released an update to its previous 2017 guidance (“Updated Guidance”) outlining when the government will award cooperation credit to defendants in False Claims Act (“FCA”) investigations. Under the Updated Guidance, set forth at Justice Manual Section 4-4.112, defendants can earn cooperation credit in FCA cases in three primary ways.
On March 25, 2019, the Office of Inspector General (OIG) published its Medicaid Fraud Control Units Fiscal Year 2018 Annual Report. Forty-nine states and the District of Columbia have a Medicaid Fraud Control Unit (MFCU) which is responsible for
Anthem Inc. has agreed to a US$115 million settlement to resolve a class action lawsuit relating to a 2015 cyberattack that compromised data on 79 million individuals. Anthem has denied any wrongdoing.
In February of 2015, Anthem reported that hackers
On July 11 the U.S. Department of Justice (DOJ) announced a new Task Force on Market Integrity and Consumer Fraud. The wide-ranging Task Force will be chaired by the Deputy Attorney General and work towards:
[T]he investigation and prosecution of
Last week, the U.S. Department of Justice announced charges against 601 individuals for their alleged participation in healthcare fraud schemes. According to the announcement, the alleged fraud is estimated to have resulted in more than $2 billion in losses to