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Government Agencies Focus on PE Firms in Health Care

Posted 03/6/24

pill container spilled over with pills in the form of a dollar sign

The government has increased its scrutiny of PE firms and other investors in healthcare companies. Yesterday, the government announced a joint effort between the Department of Justice (DOJ), the Federal Trade Commission (FTC), and the Department of Health and Human Services (HHS), to inquire into “private-equity and other corporations’ increasing control over health care.” This may signal increased...

Tagged in: Healthcare Fraud,

Catch of the Week - Endo Health Solutions

Posted 03/1/24

This week's Department of Justice (DOJ) Catch of the Week goes to Endo Health Solutions. Yesterday (February 29), the now-bankrupt pharmaceutical company agreed to pay up to $465 million over 10 years to settle criminal and civil charges relating to its sales and marketing of the opioid drug Opana. Endo voluntarily withdrew the drug from the market in 2017. This bankruptcy-negotiated payout flows from a...

Tagged in: Catch of the Week, Criminal Proceedings, FCA Federal, Healthcare Fraud, Pharma Fraud,

DOJ Releases False Claims Act Results for 2023

Posted 03/1/24

The Department of Justice (DOJ) just released its False Claims Act results for 2023. By all accounts, it was another big year for the government's primary fraud-fighting tool. The top-line numbers are roughly $2.7 billion in total recoveries from 543 settlements and judgments, the highest number of settlements and judgments in a single year. This brings the total tally of False Claims Act recoveries to more than...

Tagged in: FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers,

DOJ Principal Deputy Assistant Attorney General Credits Whistleblowers, Identifies 2024 Priorities

Posted 02/27/24

DOJ Principal Deputy Assistant Attorney General Brian Boynton recently spoke at the 2024 Federal Bar Association’s Qui Tam Conference. Here are a few key takeaways from his remarks, which can be found here.

Crediting Whistleblowers. Boynton lauded whistleblowers, calling them “a critical source of [DOJ’s] enforcement efforts,” and he thanked them and their counsel for their efforts, adding that the DOJ...

Tagged in: COVID-19, Cybersecurity and Data Breaches, FCA Federal, Government Programs Fraud, Healthcare Fraud,

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted 02/23/24

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

Tagged in: FCA Federal, Government Programs Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud, Reporting to Government,

Catch of the Week: Lincare, Inc.

Posted 02/16/24

This week's Department of Justice (DOJ) Catch of the Week goes to Lincare, Inc., a durable medical equipment supplier with locations throughout the country. Yesterday (February 15), the company agreed to pay $25.5 million to settle DOJ charges of violating the False Claims Act by billing Medicare for the rental of non-invasive ventilators (NIVs) when patients no longer needed or used them. DOJ also charged Lincare...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs, Whistleblower Case,

Top Ten Healthcare False Claims Act Recoveries for 2023

Posted 01/30/24

Doctor Holding Stethoscope with Crossed Arms

This past year was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. And as we noted in our recent Top Ten listing of False Claims Act recoveries for 2023, all but 3 of the Top Ten recoveries were in the healthcare space involving various schemes to defraud Medicare and Medicaid. So here is our look at the Top Ten healthcare recoveries for...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

Catch of the Week: New York-Presbyterian Hospital

Posted 01/26/24

This week's Department of Justice (DOJ) Catch of the Week goes to New York-Presbyterian Hospital. Yesterday (January 25), the hospital agreed to pay $801,000 to settle charges it violated the False Claims Act by billing Medicare, Medicaid and TRICARE for medically unnecessary images for radiation therapy treatments provided to cancer patients. The settlement is notable not for the relatively small amount of money...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

Silver Lake Hospital and Investors Pay $30 Million to Settle Health Care Case

Posted 01/22/24

Silver Lake Hospital, operating as Columbus LTACH in Newark, New Jersey, and certain investors recently agreed to pay a combined $30.6 million to settle False Claims Act allegations relating to Medicare payments and violations under the Federal Debt Collection Procedures Act (FDCPA). Silver Lake is a long-term care hospital a whistleblower alleged was claiming excessive "cost outlier" payments from Medicare, a...

Tagged in: FCA Federal, Healthcare Fraud, Medicare,

Testing Lab and Owner/CEO Settle False Claims Act Case for $13.25 Million

Posted 01/12/24

Laboratory Analysis. Scientist Measuring Sample

RDx Bioscience Inc. (“RDx”), a clinical laboratory that operated in New Jersey, and its owner and CEO agreed to pay $13.25 million to settle a False Claims Act case alleging kickbacks and unnecessary testing schemes, according to a recent DOJ press release. The press release also notes that RDx and its owner/CEO agreed to cooperate with the DOJ’s “investigations of, and litigation against, other participants...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity,

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Government Agencies Focus on PE Firms in Health Care

Catch of the Week - Endo Health Solutions

DOJ Releases False Claims Act Results for 2023

DOJ Principal Deputy Assistant Attorney General Credits Whistleblowers, Identifies 2024 Priorities

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Catch of the Week: Lincare, Inc.

Top Ten Healthcare False Claims Act Recoveries for 2023

Catch of the Week: New York-Presbyterian Hospital

Silver Lake Hospital and Investors Pay $30 Million to Settle Health Care Case

Testing Lab and Owner/CEO Settle False Claims Act Case for $13.25 Million

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