Tagged: false claims act

23 Oct, 2024

Teva Pharmaceuticals Pays $450 Million to Resolve Anti-Kickback and False Claims Act Violations

Teva Pharmaceuticals USA Inc. (Teva USA) and Teva Neuroscience Inc. (“Teva”) agreed to pay $450 million to resolve two matters that allege Teva violated the Anti-Kickback Statute (AKS) and the False Claims Act (FCA). Teva is the largest generic drug manufacturer in the United States. The settlement resolved two alleged kickback schemes: Medicare Cost-Sharing Scheme and Copay Assistance Foundations First, Teva has agreed to resolve...

General

18 Sep, 2024

Oak Street Health Pays $60 Million to Resolve False Claims Act Violations

Federal whistleblowers have been exposing health care fraud for years. The False Claims Act (“FCA”) contains robust whistleblower provisions and protections that reward whistleblowers with financial payouts. The process for whistleblower submissions is well-established, and the Justice Department has a robust investigative function to sift through the whistleblower complaints. If the Justice Department decides to intervene in support of the whistleblower’s claim, nearly 100 percent...

General

2 Aug, 2024

Gentiva Pays $19.4 Million for False Claims Act Violations Involving Hospice Care

Gentiva, the renamed former Kindred at Home, agreed to pay $19.4 million to resolve claims that its predecessor company, Kindred at Home and related companies, violated the False Claims Act by retaining overpayments for hospice services provided to patients. Gentiva’s hospice operations, based in Atlanta, include various organizations that previously operated hospice locations under various brand names including Avalon, Kindred, SouthernCare and SouthernCare New Beacon....

General

24 Jul, 2024

DaVita Pays $34 Million to Settle Kickback Violations

DaVita is a regular target of government enforcement actions involving fraud and illegal kickbacks. It has an extensive history of violations and settlements. here is a list of some of the highlights:: In its most recent settlement, DaVita paid just over $34 million to resolve claims that it violated the Anti-Kickback Statute (“AKS”) by paying kickbacks to induce referrals to DaVita Rx, a former subsidiary...

General

23 Jul, 2024

The Continuing Plague of Healthcare Fraud

Healthcare fraud is an ever-growing constant in our economy. It is a battle that presents new and exponential challenges. The U.S. Department of Justice, the HHS-Office of Inspector general and State Attorneys’ General all are united in this fight with the support of federal state and local law enforcement. Companies in the healthcare sector continue to operate in this high-risk environment. The war against healthcare...

General

24 Oct, 2023

Cigna Group Falls Under the False Claims Axe and Pays Over $172 Million for Abuse of Medicare Advantage Program

As if corporate healthcare businesses needed an enforcement reminder, DOJ recently announced a settlement with Cigna Group for $172 million to resolve claims that Cigna exaggerated patient illnesses to extract more money from the Medicare Advantage Program. Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries have the option of obtaining their Medicare-covered benefits through private insurance plans called MA...

Podcasts

10 Jul, 2023

Episode 280 — Healthcare Compliance and Fraud

Looking back in time, the compliance field owes a lot to the healthcare industry. In the 1990s, there was a dramatic explosion in the industry in response to aggressive federal enforcement programs and increasing regulation. All of a sudden, compliance officers who sat in the backrooms of legal departments were “volunteered” to address proactive compliance. Federal regulators pushed the compliance function to assume a much...

General

28 Jun, 2023

The Unique Elements of Healthcare Compliance Programs (Part II of II)

Corporate compliance programs in the healthcare industry include many of the same elements that we are all familiar with – risk assessments, code of ethics, written policies and procedures, comprehensive training requirements, confidential reporting and investigation systems to address employee concerns, gifts, meals, grants, and medical education programs, and audit and review processes to maintain a continuous improvement program. Aside from this standard list of...

General

27 Jun, 2023

The Challenge of Healthcare Compliance Programs (Part I of II)

If you are a compliance officer for a healthcare provider (e.g. hospital, HMO, skilled nursing facility, hospice center), you must sometimes feel that no one understands or feels your pain. When you consider the number and extent of risks, it can be mind-boggling. I am sure there are times that compliance officers in the healthcare industry look wistfully or even with envy at a compliance...

General

7 Jun, 2023

The Supreme Court Rejects Challenge to False Claims Act Intent Standard

The Supreme Court , in a unanimous decision, rejected a challenge by corporate pharmacy defendants, to the intent requirement in a Medicaid and Medicare over-billing False Claims Act case. Justice Clarence Thomas, who has established himself as the lead justice concerning False Claims Act cases, wrote the unanimous opinion. The defendants, SuperValu and Safeway, claimed that thier alleged overbilling did not meet the intent requirements...