Jessica Sanderson, Of Counsel, The Volkov Law Group, joins us for her initial posting on the False Claims Act. Jessica can be reached at [email protected]. On December 21, 2018, the Department of Justice (“DOJ”) released its Fraud statistics showing $2.8 billion recovery under the False Claims Act (“FCA”) for 2018.[1] While this number is staggering, fiscal year 2018 FCA recoveries were down more than ½...
The federal government continues to push aggressive False Claims Act enforcement cases against healthcare companies, including hospitals, skilled nursing facilities, hospices and other healthcare providers. The Justice Department has employed the False Claims Act to target companies in the opioid industry as a response to the opioid crisis in our country. Healthcare companies have to implement effective ethics and compliance controls to protect against fraud...
Despite the controversial impact of the Supreme Court’s Escobar decision, the Justice Department’s False Claims Act prosecutions and settlements are continuing at a consistent rate – heading towards another multi-billion dollar year of FCA recoveries. Some examples of these prosecutions and settlements will demonstrate my overall point – FCA risks are significant and healthcare providers, especially hospitals, have to devote time and attention to oversight...
The Justice Department has continued to pursue healthcare fraud and bribery criminal prosecutions. Healthcare fraud remains a high priority for criminal enforcement. With the pervasive problem of fraud and bribery, the healthcare industry continues to suffer from corrupt officials and physicians. Government regulation of the healthcare industry provides many opportunities and incentives for industry participants to cheat the system. In a recent case, the Justice...
Webinar: Healthcare Providers — The Need to Enhance Your Ethics and Compliance Program Tuesday, April 10, 2018, 12 Noon EST Sign Up Here Healthcare providers continue to face significant enforcement risks. Federal and state regulation of healthcare providers creates numerous risks, including the possibility of criminal fraud prosecutions. False Claims Act prosecutions continue to threaten healthcare providers with potential parallel criminal and civil proceedings. In...
The healthcare industry continues to be a frequent target for criminal prosecutions. More importantly, federal prosecutors are ready, willing and able to bring criminal cases against C-Suite actors involved in healthcare fraud cases. Sometimes prosecutors win their cases, and sometimes they lose. That is just the nature of the beast. ArthroCare stands as yet another example of the destruction of a company resulting from C-Suite...
Let’s start out with something ironic – the C-Suite typically resists the need for ethics and compliance training, as well as other compliance controls, claiming that they know everything about ethics and compliance. Unfortunately, when a member or members of the C-Suite commit misconduct, the consequences can be devastating for the company. We all know high-profile instances of C-Suite misconduct involving bribery, fraud, and theft....
Chief compliance officers face an overwhelming level of risk in the healthcare sector. I do not mean to belittle the risks of corruption, AML, sanctions and other risks typically associated with global companies. Healthcare companies face an extraordinary mix of risks, including fraud, data security, bribery/anti-kickback, and Stark Law violations. The False Claims Act statute is a prosecutor’s dream, and organizations and individuals face extraordinary...
Jacqui Merrill, an Associate at The Volkov Law Group, rejoins us for a posting on DOJ’s largest healthcare fraud takedown. Jacqui’s profile is here and she can be reached at [email protected]. On Wednesday, June 22, 2016, the DOJ announced the largest nationwide heath care fraud takedown in history, which resulted in criminal and civil charges against 301 individuals for alleged participation in health care fraud...
The headline on Medicare last week was astounding — $60 billion (not million) was lost each year to Medicare fraud, large numbers of fraudulent providers were providing fake or badd addresses – meaning locations including hamburger stands, vacant lots, mailbox shops. According to a recent GAO report (here), Medicare pays money to fraudsters at approximately 23,400 fake or bad addresses (22 percent of all provider...
