In Universal Health Services v. U.S. ex rel Escobar, the United States Supreme Court emphasized the importance of the materiality standard in False Claims Act cases. Since that decision, litigants have anxiously awaited further guidance on how Escobar’s instructions would
DOJ policy shift in qui tam litigation?
Last week, a senior US Department of Justice official appeared to announce a surprising, and potentially significant, shift in policy regarding qui tam litigation. Michael Granston, director of the commercial litigation branch of the fraud section in the DOJ’s civil
DOJ charges 412 individuals in largest healthcare fraud takedown in US history
On Thursday, the DOJ announced charges against 412 individuals for their alleged participation in healthcare fraud schemes involving approximately $1.3 billion in false billings. This marks the largest national healthcare fraud takedown in U.S. history—topping the DOJ’s announcement of charges
DOJ recovers $4.7 billion in 2016, third highest in FCA history
The Department of Justice (“DOJ”) announced yesterday that it recovered over $4.7 billion in fiscal year 2016 in civil cases involving claims of fraud against the government under the False Claims Act (“FCA”). This is the third largest annual recovery
FTC and DOJ side with Texas-based Teladoc
The Federal Trade Commission (“FTC”), in a joint amicus brief with the Department of Justice filed on September 9, 2016, petitioned the Fifth Circuit to dismiss the Texas Medical Board (“TMB”) appeal of the district court ruling holding that TMB regulations restricting the prescribing rights of physicians providing professional services through telemedicine may be challenged under federal anti-trust laws. The FTC asserted that the appellate court does not have jurisdiction over the issue because there has been no final judgment in the underlying case between Teladoc and the TMB.
HHS announces near-doubling of civil penalties for numerous infractions
Last week, HHS, OIG, CMS, the Office of the Assistant Secretary for Financial Resources, and the Administration for Children and Families issued an interim final rule (the Rule) that adjusts maximum civil monetary penalties for inflation.
CMS investment in preventing healthcare fraud brings $42 billion return
CMS’s annual report demonstrates that the government is becoming increasingly effective at ferreting out fraud and abuse from the healthcare system. With a 12-to-1 return on investment, the government will likely continue to make fighting healthcare fraud a priority.
2015 CMS “Open Payments” data released
Last week, CMS posted the 2015 Open Payments data to its website, as well as updated payment records for 2013 and 2014. Overall, manufacturers reported $7.52 billion in payments and ownership interests to 618,931 physicians and 1,116 teaching hospitals in 2015. Nearly 1,500 companies reported making payments in 2015, comprising a total 11.9 million records. Although the total number of records and amounts of payment are comparable from 2014 to 2015, there are shifts in the reporting of the nature of payments.
Legal Update: DOJ announces near doubling of FCA penalties
The DOJ has confirmed that the amount of False Claims Act civil penalties is set to nearly double following recent updates to FCA regulations.
DOJ charges over 300 people in largest healthcare fraud “takedown” in U.S. history
On Wednesday, the Justice Department announced that it had brought criminal and civil charges against 301 healthcare professionals as part of the largest national healthcare fraud “takedown” in history. A nationwide investigation spearheaded by the Medicare Fraud Strike Force revealed claims amounting to $900 million in the form of alleged kickbacks, money laundering, and other false billings.