The Justice Department reported its 2018 fraud statistics showing $2.8 billion in recoveries under the False Claims Act. While this number is staggering, fiscal year 2018 recoveries were down from than $500 million from fiscal year 2017. Nonetheless, companies in the healthcare, defense and financial industries continue to face significant False Claims Act risks. In this episode, Michael Volkov interviews Jessica Sanderson, Of Counsel, at...
The Justice Department’s commitment – resources and public statements – has continued at a steady pace in the Trump Administration. Some might diminish the effort by recognizing that fraud is so pervasive that it is like shooting fish in a barrel. In the end, however, criminal cases require investigation, organization, resources and hard work. As you would expect, Florida is a prime geographic target for...
Global companies need to actively work to prevent fraud and corruption. Fraud and corruption go hand-in-hand. To commit bribery, bad actors have to gain access to money for unauthorized (illegal) purposes. A failure to prevent fraud and corruption can have significant legal, financial and reputational consequences. Luckily, companies are devoting additional resources to assess fraud and bribery risks with specific focus on internal financial and...
The False Claims Act is the government’s weapon of choice in fighting healthcare fraud. In the beginning of the Obama Administration, Congress amended the False Claims Act and enacted a wish list from DOJ prosecutors. Healthcare companies have no choice but to negotiate settlements since they risk exclusion from federal healthcare programs, the equivalent of a death sentence for healthcare businesses. United Healthcare is...
Earlier this year, in January 2017, Western Union entered into a Deferred Prosecution Agreement with the Justice Department and the FTC, and agreed to pay $586 in forfeiture to settle anti-money laundering and consumer fraud violations. At the same time, Western Union agreed to pay $184 million in civil monetary penalties for AML violations. The Western Union prosecution sends an important reminder to financial institutions,...
Two executives were charged last week with criminal violations in the Southern District of New York relating to Valeant Pharmaceuticals activities. These charges are the first of more to come in an ongoing investigation focusing on Valeant’s corporate demise from a high-flying pharmaceutical company. I have written before about Valeant’s rotten culture, slavish devotion to quarterly performance, and short-sighted management culture that ultimately bred a...
In the risk mitigation business, we often focus on legal risks, such as anti-corruption, sanctions, export controls, antitrust and AML. As compliance programs mature, and the CCOs focus on proactive strategies, one key issue is conflict of interest. My experience with conflict of interest issues has confirmed that such conflicts often mask more serious compliance issues relating to fraud and even legal violations. As such,...
Healthcare organizations – ranging from physician practice groups to large, multi-state hospital systems – face a variety of risks, including fraud and abuse, as well as HIPAA privacy issues. Starting from a baseline risk assessment, healthcare organizations are often juggling among competing risks and responding to enforcement threats. The design and implementation of an effective healthcare compliance program is extremely difficult and requires dedication, resources,...
The political campaign season has included plenty of discussion surrounding reforming our criminal justice system, and in particular sentencing for drug offenses. We have not heard much discussion about white-collar criminal sentencing. There is a fair amount of controversy surrounding while collar criminal sentencing as well. Ever since the Supreme Court’s decision in United States v. Booker, in which the Supreme Court relegated the U.S....
When commentators criticize the FCPA for its broad coverage of international business operations, these same commentators would have real trouble with the US Anti-Kickback statute. Talk about broad coverage and then complicate it with specific exemptions that are challenging to interpret and apply. When it comes to fraud enforcement in the healthcare industry, the Justice Department wields a mighty stick – the False Claims Act....
