Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicare Medicare Governance 40

The Health Law Firm

SEPTEMBER 20, 2013

This accusation comes after the Florida Agency for Health Care Administration (AHCA) conducted an audit of claims from July 2007 to March 2011. Indest III, J.D., The audit allegedly found that the home health care company was overpaid for services that were not covered by Medicaid, according to the Sun Sentinel.

Medicaid 40

Medicaid Medicaid Fraud 40

The Health Law Firm

SEPTEMBER 23, 2013

The providers were accused of defrauding Medicare, Medicaid and TRICARE by performing unnecessary and improperly supervised procedures from 2007 until 2011. Indest III, J.D., Board Certified by The Florida Bar in Health Law A group of Florida radiation oncology service providers settled a whistleblower or qui tam lawsuit for $3.5

Fraud 40

Fraud Medicaid Medicaid Medicare 40

American Medical Compliance

JANUARY 9, 2024

Provider Compliance and Responsibilities Additionally, the federal government’s False Claims Act (FCA) of 1986 explicitly targeted fraud and abuse in the healthcare industry in an effort to eliminate it. HCFAC received $248,459,000 from HHS and the Attorney General in 2007 to combat healthcare fraud and abuse.

Fraud 52

Fraud Compliance HIPAA Health Insurance 52

Verisys

FEBRUARY 1, 2022

The UPIN Registry was discontinued in 2007 when CMS replaced UPINs with NPI numbers as the preferred provider identification number. Tracking actions to a standardized identifier provides transparency that can identify and impede fraud. NPI Helps Prevent Healthcare Fraud . How Do You Get an NPI Number? Written by Verisys.

Fraud 52

Fraud Medicare Medicare HIPAA 52

Health Law RX

JANUARY 31, 2023

And some jurists are cynical about the impact of applying an objective standard to government fraud cases. Therefore, the Court held, the defendants could not be liable under the FCA. The district court, as well as the Seventh Circuit on appeal, applied the Supreme Court’s reasoning in Safeco Ins. of America v. Burr , 551 U.S.

Governance 52

Governance Fraud Compliance 52

Health Law RX

JUNE 2, 2023

The Prior SafeCo Standard Until yesterday, defendants could seek dismissal of fraud claims based on the absence of scienter by relying on the two-part test codified by the Court in SafeCo Ins. A mistake is still a mistake, not fraud. of America v. 3] That test posed two questions. 1] United States ex rel. SuperValu Inc. , of America v.

Fraud 52

Fraud Governance Medicaid Medicaid 52

Hall Render

JANUARY 4, 2023

James assists clients, which include hospitals, health systems, federally qualified health centers and safety net providers, as they navigate the complex 340B program, drug distribution laws, and fraud and abuse rules that regulate the health care industry. McKinney School of Law in 2007.

Fraud 40

Fraud Compliance Hospitals 40

Hall Render

APRIL 6, 2022

Regarding the PBM’s adoption of this definition, the Court stated that this may not serve as the basis of a fraud claim under the FCA. SuperValu Inc., held that the scienter requirement articulated by the Supreme Court of the United States in Safeco Ins. of America v. Burr was applicable to lawsuits brought under the False Claims Act.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Health Care Law Brief

JUNE 20, 2023

Because the FCA incorporates the common law of fraud, it embodies that same limitation. Given that such statements included false facts, there was a potentially valid fraud theory, even under the defendants’ common‑law rule. See Safeco Ins. of America v. Burr , 551 U.S.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Verisys

DECEMBER 29, 2024

By 2007, all providers were required to file claims using their NPI, replacing the previous Unique Physician Identification Number (UPIN). How Verisys Utilizes NPI Data: Verisys leverages NPI data through its healthcare provider credentialing solutions to enhance fraud prevention and ensure data accuracy.

HIPAA 52

HIPAA Fraud Health Insurance Medicare 52

AIHC

JUNE 3, 2024

The rate of nonfatal assaults increased by more than 75% among men (2002–2016) and more than 35% among women (2007–2016). The article states that Americans over 60 years of age fell victim to so-called elder fraud crimes more frequently last year than during any other year and accounted for an estimated $3.4 seniors account for $3.4

Elder Abuse 52

Elder Abuse Compliance Nursing Homes Compliance Officers 52

Healthcare Law Blog

APRIL 19, 2023

Justice Kagan reasoned that the Court in Escobar noted the FCA is grounded in common law fraud principles under which a defendant’s subjective knowledge of the truth or falsity of its statement is relevant to the knowledge inquiry. And, based on that decision, the D.C. Circuit, in a decision joined by then D.C.

Governance 52

Governance Fraud Compliance 52

Hall Render

JUNE 7, 2023

47 (2007), the U.S. 47, 70 (2007). [10] In SuperValu , the Supreme Court clarified that the FCA’s scienter element refers to a defendant’s actual knowledge and subjective beliefs about the truth of their claims at the time of submission. [7] 8] In Safeco Insurance Company of America v. Burr , 551 U.S. Safeway, Inc.). [2] 4] 31 U.S.C.

Fraud 40

Fraud Medicaid Medicaid Governance 40

Healthcare Law Blog

FEBRUARY 13, 2023

This topic always involves a legal angle, such as Stark Law or Anti-Kickback compliance, or state fraud and abuse law considerations. For many healthcare attorneys, these types of dual-purpose communications are more common than communications involving only purely “legal” advice. For example, consider physician compensation. of Erie), 473 F.3d

Compliance 52

Compliance Fraud Governance 52

Innovaare Compliance

FEBRUARY 9, 2021

Launched in 2007, star ratings enable the CMS as well as consumers to compare health plans on metrics other than cost. Inovaare’s A&G software optimizes your processes so you can handle large volumes of data, reduce costs and ensure transparency to prevent fraud at every step. The CMS star ratings challenge.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Drug & Device Law

DECEMBER 21, 2023

We’ve been diligently preparing bottom ten annual lists since 2007, even though it’s distasteful, because if we don’t do it nobody else is likely to, and these abominable decisions deserve to be called out for what they are. The logic of the consumer fraud claim made no sense. The penalty did not hold up, but the duty did.

FDA 52

FDA Fraud Informed Consent 52

Drug & Device Law

NOVEMBER 10, 2023

Not a single state, including Pennsylvania, allows recover of medical monitoring for “breach of warranty or fraud or violation of consumer protection statutes,” and Valsartan doesn’t cite any precedent for its contrary conclusion. 2023 WL 1818922, at *36.

FDA 59

FDA Governance Fraud 59

Drug & Device Law

FEBRUARY 2, 2023

2007 WL 4042757, at *3 (N.D. 15, 2007); McNeil v. Atkinson pointed out that the main exception – fraud on the FDA − to this otherwise not easily rebutted presumption of warning adequacy is preempted. Novartis Pharmaceuticals Corp. , 2d 898, 909-10 (W.D. 2013); Massa v. Genentech Inc. 2012 WL 956192, at *5 (S.D. 3d 364 (5th Cir.

FDA 59

FDA Licensing Fraud 59

Drug & Device Law

AUGUST 8, 2022

The unfortunate truth is that ECFMG was also a victim of this fake doctor’s fraud. Ohio 2007) (“courts have repeatedly held that trade associations, themselves, have no duty to users of products in that trade”); Commerce & Industry Insurance Co. Typically overblown MDL claims for “fraud” and “conspiracy” also failed.

Doctors 52

Doctors Fraud Licensing Compliance 52

Drug & Device Law

MAY 26, 2022

9(b), “[i]n alleging fraud or mistake, a party must state with particularity the circumstances constituting fraud or mistake.” In particular, MDLs seem to have an unfortunate habit of allowing general allegations to support fraudulent misrepresentation claims and other claims based on alleged fraud or mistake. Under Fed.

Fraud 59

Fraud FDA Doctors 59

Drug & Device Law

APRIL 21, 2022

544 (2007), and Ashcroft v. The plaintiff asserted all the usual claims and then one: manufacturing defect; failure to warn; breach of warranty; and fraud. Defendants love and plaintiffs hate Bell Atlantic Corp. Twombly , 550 U.S. Iqbal , 556 U.S. Today’s case, Poozhikala v. Medtronic Inc. 2022 WL 1076173 (C.D.

FDA 59

FDA Fraud 59

Drug & Device Law

MARCH 7, 2022

544 (2007), and Ashcroft v. Here, Plaintiffs fail to supply factual support showing Defendant acted with “oppression, fraud, or malice,” relying instead upon conclusory allegations. Punitive damages are available when the evidence shows that the defendant acted with fraud, malice, or gross negligence. . . . [T]he 2, 2020). “In

Fraud 59

Fraud FDA Licensing Pharmaceutical Industry 59