Tagged: healthcare fraud

DOJ Declines Prosecution Applying Corporate Enforcement Program in Healthcare Fraud Case

DOJ Declines Prosecution Applying Corporate Enforcement Program in Healthcare Fraud Case

The Justice Department’s Corporate Enforcement Policies and Program applies to prosecutions outside of the FCPA context.  The impact of DOJ’s new approach, encouraging voluntary disclosures, applies to other federal criminal cases, such as healthcare fraud.  In a recent action, DOJ declined to prosecute HealthSun Health Plans (“HealthSun”) for violations of wire fraud and healthcare fraud. From 2015 until 2020, HealthSun’s former Director of Medicare Risk...

DOJ Arrests 78 Defendants in Nationwide Crackdown on Healthcare Fraud

DOJ Arrests 78 Defendants in Nationwide Crackdown on Healthcare Fraud

Healthcare fraud continues to plague the industry – each year Medicare and Medicaid suffer over $100 billion in losses from fraudsters. Prosecuting fraud cases in the healthcare industry is like shooting fish in a barrel – there are an infinite number of targets. To publicize its efforts, each year, DOJ executes multiple nationwide takedowns, rounding up healthcare fraudsters across the nation.  In its most recent...

DOJ Announces Two Significant Indictments Charging Individuals with Healthcare Fraud

DOJ Announces Two Significant Indictments Charging Individuals with Healthcare Fraud

The Justice Department is continuing to use criminal enforcement as an important tool in the fight against healthcare fraud.  While the False Claims Act continues its important place in the fight against healthcare fraud, DOJ has used the criminal laws to prosecute players in significant fraud cases.  Five Individuals and Two Nursing Facilities, Pittsubrugh, PA: Five individuals and two for-profit skilled nursing facilities were indicted...

DOJ Continues Pace of Healthcare Fraud False Claims Act Prosecutions

DOJ Continues Pace of Healthcare Fraud False Claims Act Prosecutions

False Claims Act prosecutions continue against healthcare executives, physicians and professionals.  Last year, DOJ recovered over $5.6 billion in FCA enforcement. DOJ expects total recoveries to increase in 2022.  Over 95 percent of False Claims Act prosecutions involved healthcare fraud and kickbacks.  Two Doctors and Eight Others Indicted for Healthcare Kickbacks In a recent prosecution in the Northern District of Texas, DOJ announced the indictment...

2021 False Claims Act Year in Review: Enforcement Statistics (Part I of II)

2021 False Claims Act Year in Review: Enforcement Statistics (Part I of II)

Worth the Wait? DOJ finally released its Fraud Statistics for FY 2021 and announced the “second largest amount recorded” since 1986: FCPA Settlement and judgment exceed $5.6 billion Jessica Sanderson, Partner at The Volkov Law Group, joins us for her annual review of False Claims Act enforcement and issues. In Part I, Jessica reviews the enforcement statistics. In Part II, Jessica discusses False Claims Act...

False Claims Act 2020 Year in Review: The FCA “Has Never Been More Important Than it is Right Now”

False Claims Act 2020 Year in Review: The FCA “Has Never Been More Important Than it is Right Now”

Jessica Sanderson, Partner at The Volkov Law Group, joins us for her annual False Claims Act Review. Jessica can be reached at [email protected]. $1.9 trillion dollars of federal spending on the horizon. That’s right, immediately following his inauguration in 2021, President Biden proposed a $1.9 trillion stimulus plan to help recover from the COVID-19 pandemic. This follows the approximately $3.5 trillion of federal government funds...

False Claims Act 2019 Year in Review

False Claims Act 2019 Year in Review

Jessica Sanderson, Of Counsel at The Volkov Law Group rejoins us for her annual review of False Claims Act enforcement. Jessica can be reached at [email protected]. 2020 marks the 150th anniversary of the Department of Justice (“DOJ”), and it unwrapped a nice gift: On January 9, 2020, DOJ released its Fraud Statistics showing that it obtained more than $3 billion under the False Claims Act...

Episode 124 — False Claims Act 2019 Review

Episode 124 — False Claims Act 2019 Review

The Justice Department continues to aggressively pursue False Claims Act cases.  In 2019, DOJ recovered over $3 billion from healthcare, defense and financial companies.  The heath care sector — pharmaceutical, medical device, hospitals and healthcare providers — continues to be the primary focus of False Claims Act cases.  Qui tam relators initiate a significant percentage of all False Claims Act cases. In this episode, Michael Volkov...

Episode 115 — Review of Recent Healthcare Fraud Enforcement Actions

Episode 115 — Review of Recent Healthcare Fraud Enforcement Actions

The Justice Department has aggressively continued to pursue False Claims Act prosecutions against healthcare companies and physicians.  By the mid-point of 2019, DOJ had collected over $800 million against pharmaceutical and healthcare professionals.  In the last few months, DOJ has brought several significant prosecutions. In this Episode, Michael Volkov reviews recent healthcare fraud enforcement cases.

Checking in on Criminal Healthcare Fraud Prosecutions

Checking in on Criminal Healthcare Fraud Prosecutions

For criminal defense practitioners, it is easy to lose perspective when focused on FCPA, export control/sanctions and AML prosecutions.  In the healthcare fraud area, prosecutors continue to aggressively enforce anti-kickback and fraud statutes through criminal prosecutions. The Justice Department has made its priority in this area clear – by dedicating law enforcement resources and prosecutors to investigating and prosecuting healthcare fraud schemes.  As government participation...