Health Law Advisor

FEBRUARY 3, 2022

FY 2021 was also a record-shattering year for DOJ as it relates to health care fraud enforcement; over $5 billion (90% of the total) was obtained from cases pursued against individuals and entities in the health care and life sciences industries. With collections amounting to $5.6 billion received in FY 2020. KEY TAKEAWAYS.

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Fraud COVID-19 Governance Medicare 52

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. The new broker provision aims to deter fraudulent sign-ups by clarifying that applicants must attest that the income projections listed are correct.

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ACA Health Insurance Licensing Governance 80

Healthcare Compliance Blog

FEBRUARY 8, 2022

From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

C&M Health Law

APRIL 21, 2022

Florida Medicaid is administered by the state but jointly funded by both the state and federal governments. The federal government’s Federal Financial Participation (FFP) share is paid according to statements of expenditures submitted by the state and per the formula described in sections 1903 and 1905(b) of the Medicaid Act.

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Medicaid Medicaid Governance Fraud 52

HIPAA Journal

JULY 27, 2023

The stolen information included names, addresses, email addresses, dates of birth, Social Security numbers, government identification ID numbers, driver’s license numbers, payment/financial institution information, health insurance providers, medical treatment information, medical diagnoses, medications, medical images, and lab test results.

Ransomware 52

Ransomware Fraud Licensing Health Insurance 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. What is Healthcare Compliance?

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Compliance HIPAA Telemedicine ACA 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud.

Licensing 52

Licensing Fraud Compliance Nurses 52

Healthcare Law Today

JANUARY 2, 2023

The FCA is a fraud statute, requiring intent. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. Potential Impact. ” United States ex rel. Healthfirst, Inc. ,

Overpayment 52

Overpayment Overpayments ACA Medicare 52

Hall Render

APRIL 6, 2022

Turning to the present case, in Safeway , the relator alleged that the defendant engaged in the submission of false claims to the government when it “reported its ‘retail’ price for certain drugs as its ‘usual and customary’ price.” Rather, this potentially qualifies as a breach of contract between the PBM and the pharmacy.

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Medicare Medicare Medicaid Medicaid 72

Hall Render

AUGUST 22, 2023

Rather, liability under the FCA may still be established if any misrepresentations made by a provider influenced decision-makers and resulted in the submission of false claims to the government. Walgreens learned of the fraud as early as 2016. In United States v. Walgreen Co. ,

Medicaid 40

Medicaid Medicaid Governance Fraud 40

Healthcare Law Blog

APRIL 19, 2023

The issue is a significant one for both the government and relators on one side, and potential defendants on the other, as False Claims Act (FCA) liability imposes treble damages and penalties exceeding $20,000 per claim as well as relators’ attorneys’ fees and costs. The Court’s questioning did not signal the likely decision.

Governance 52

Governance Fraud Compliance 52

Hall Render

JUNE 1, 2022

For more than 15 years, Ritu has been an active member of AHLA and has held leadership roles consistently since 2015. “AHLA has played an integral role in my growth as an attorney, and I look forward to the opportunity to help guide this organization and bring industry leaders together to advance how we are able to best serve our clients.”.

Compliance 40

Compliance Fraud Governance Hospitals 40

Verisys

NOVEMBER 14, 2023

A healthcare facility’s accountability and overall reputation are dependent upon rigorous credentialing processes compliant with governing regulatory bodies, such as the National Committee for Quality Assurance. Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Verisys

JANUARY 18, 2022

A healthcare facility’s accountability and overall reputation are dependent upon rigorous credentialing processes compliant with governing regulatory bodies, such as the National Committee for Quality Assurance. Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Healthcare Law Blog

FEBRUARY 9, 2024

Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance. Million To Resolve Health Care Fraud Allegations | United States Department of Justice [3] See Defs.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Health Law RX

JULY 18, 2023

The CMP Final Rule also addresses enforcement and CMPs for fraud, false claims, or similar conduct in HHS grants, contracts, and other agreements, which are not addressed in this article. As context, between 2015 and 2022, the DOJ reported FCA settlements with health IT vendors in an amount exceeding $500 million.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Health Law RX

AUGUST 10, 2021

On July 21, 2021, the DOJ announced that the government settled FCA claims against the Alliance Family of Companies, LLC (“Alliance”), a national electroencephalography (“EEG”) diagnostic testing company, and Ancor Holdings LP (“Ancor”), the private equity firm that invested in Alliance. Moreover, the U.S.

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Due Diligence Compliance Governance Fraud 40

Hall Render

JANUARY 3, 2025

in Medicare fraud settlement 10 behavioral health policy changes taking effect in 2025 An uncertain era for Stark law: 12 updates in 2024 CMS launches campaign to support nursing home staffing rule CMS taps 4 states for behavioral innovation model: 5 things to know Epic files to dismiss antitrust lawsuit Healthcare company to pay $15.2

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Nursing Homes Fraud Nurses Hospitals 40

Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. Yale New Haven sale key to Prospect hospitals’ survival, CEO says YNHH sale ‘paramount’ to CT Prospect hospitals’ survival, CEO says Connecticut hospital cut ED visits by nearly 50% Hartford HealthCare unveils new ‘health desk’ model Connecticut physician sentenced for $2.6M

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 40

Health Populi

JANUARY 5, 2021

When he led Turing Pharmaceuticals in 2015, he acquired a license for the drug Daraprim (an anti-malarial therapy also used for HIV/AIDS), raising the drug price from $13.50 Shkreli was ultimately convicted on securities fraud (not related to the Draprim pricing strategy). government. (In a pill to $750 a pill. In total, U.S.

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COVID-19 COVID-19 Vaccine Public Health Doctors 62

Hall Render

APRIL 21, 2023

health care fraud scheme SA cancer research company entering Dallas market as it eyes more U.S., health-tech startup MemoryWell pivots, eyes new funding to roll out software for insurers Department of Veterans Affairs health system kicks off multiyear Greater Washington expansion Georgetown to open Southeast D.C.

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nursing Homes Nurses 40

Drug & Device Law

DECEMBER 29, 2023

2023) (federal government may unilaterally obtain dismissal of FCA claims, and calling the constitutionality of the FCA’s private enforcement mechanism into question) ( here ); Quishenberry v. 2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. In 2023, these include United States ex rel. Polansky v. 3d 239 (Cal.

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FDA US Department of Health and Human Services COVID-19 COVID-19 Vaccine 105

Drug & Device Law

JANUARY 30, 2023

470 (1996), was decided – removing express preemption as a defense for manufacturers of §510(k) products So defendants moved on fraud on the FDA under an implied preemption theory and won. Mensing , 564 U.S. Mensing , 564 U.S. Lohr , 518 U.S. Davidowitz , 312 U.S. Davidowitz , 312 U.S.

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FDA Fraud Governance Medicare 72

Drug & Device Law

AUGUST 8, 2022

The unfortunate truth is that ECFMG was also a victim of this fake doctor’s fraud. Furthermore, trade associations often serve to assist the government in areas that it does not regulate. 2015 WL 6393869 (S.D. Both state and federal governments allegedly relied on the defendant “accreditation process to help evaluate HCOs.”

Doctors 52

Doctors Fraud Licensing Compliance 52

Drug & Device Law

FEBRUARY 24, 2022

341 (2001), stands for the proposition that only the federal government may enforce the Food, Drug, and Cosmetic Act and that any state-law claim that depends on the existence of the FDCA is impliedly preempted by 21 U.S.C. § 2015) (Gorsuch, J.). Plaintiffs’ Legal Committee , 531 U.S. Plaintiffs constantly try to evade Buckman.

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FDA Governance Fraud 72