Tagged: fraud

31 Jul, 2017

Double Whammy for United Healthcare: Two False Claims Act Cases in Two Weeks

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...

General

5 Apr, 2017

A Money Laundering Nightmare: Western Union Ponies Up $770 Million to Settle with DOJ, FTC and FinCEN

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,...

General

28 Nov, 2016

Two Executives Charged in Valeant Pharmaceuticals Criminal Investigation

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...

General

27 Nov, 2016

Conflict of Interest Issues – A Significant Risk

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,...

General

30 Aug, 2016

Healthcare Compliance: Juggling Risk Mitigation Strategies

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,...

General

18 Jul, 2016

White Collar Criminal Sentencing – What A Difference Cooperation Makes

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....

General

8 Mar, 2016

Anti-Kickback Enforcement – Steady and Aggressive

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....

General

16 Sep, 2015

Prosecuting Doctors for Medicare Fraud

Federal prosecutors have turned their attention to physicians for Medicare fraud prosecution. Physicians who participate in the Medicare program have to be aware of the significant risks of Medicare fraud. In June, federal law enforcement orchestrated the largest nationwide Medicare bust of all time – 243 individuals were charged, including 46 doctors, nurses, and other licensed medical professionals for their participation in Medicare fraud schemes...