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District Court Rules that Broad Measure of Damages Applies in False Claims Act Case, Greatly Increasing Defendants’ Exposure

Posted 07/21/23

Several aspects of the federal False Claims Act incentivize the government and relators to bring fraud claims to recover damages to the government. In addition to awarding relators typically between 15% and 30% of the proceeds of the action or settlement; awarding reasonable attorneys’ fees, expenses, and costs; and applying statutory penalties for each false claim submitted; the act also provides for treble...

Tagged in: Anti-Kickback and Stark, Court Decision, FCA Federal, Healthcare Fraud,

Catch of the Week: NextGen Healthcare

Posted 07/14/23

This week's Department of Justice (DOJ) Catch of the Week goes to electronic health record (EHR) technology vendor NextGen Healthcare Inc. Today, DOJ announced the company has agreed to pay $31 million to settle charges it violated the False Claims Act by misrepresenting to the government the capabilities of its EHR software and providing kickbacks to its users to induce them to recommend NextGen’s software. The...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Electronic Health Records, FCA Federal, Healthcare Fraud, Whistleblower Case,

Beware of Salty Snacks and Candy Containing THC

Posted 07/7/23

Stack of Multicolored Gummy Bears with One Standing

On Wednesday (July 5), the FTC and FDA jointly issued cease and desist letters to several companies selling various food products containing THC, the key psychoactive ingredient in marijuana. In announcing the enforcement action, the government made it clear the problem is not the sale of these products. It is how they are selling them, which according to the agencies is in almost identical packaging to many...

Tagged in: FDA Fraud, Off-Label and Unapproved Use,

Catch of the Week: National Health Care Fraud Sweep

Posted 06/30/23

This week's Department of Justice (DOJ) Catch of the Week goes to the 78 individuals criminally charged with participating in health care fraud and opioid abuse schemes across the country. On Wednesday, DOJ announced the "strategically coordinated, two-week nationwide law enforcement action" it brought with federal and state law enforcement partners, which targeted misconduct resulting in over $2.5 billion in...

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Pharma Fraud, Provider Fraud,

Catch of the Week: Smart Pharmacy, Inc.

Posted 06/16/23

This week's Department of Justice (DOJ) Catch of the Week goes to Florida-based compounding pharmacies Smart Pharmacy, Inc. and SP₂, and their owner Gregory Balotin. Yesterday, they agreed to pay at least $7.4 million to settle charges they violated the False Claims Act by adding an antipsychotic drug to topical pain creams solely to boost Medicare reimbursement. Not because of any medical purpose the drug...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case,

It's Medicare Fraud Prevention Week - What Can You Do?

Posted 06/9/23

This week is Medicare Fraud Prevention Week. You probably did not even know it because of the relative lack of attention this important week has received. All the more surprising because Medicare fraud and abuse costs the government an estimated $60 billion per year. But according to Senior Medicare Patrol (SMP), the government-sponsored public education organization, there is a lot we can do to attack this...

Tagged in: FCA Federal, Healthcare Fraud, Medicare,

Catch of the Week: Detroit Medical Center

Posted 06/2/23

Handshake in room with dark window blinds

This week's Department of Justice (DOJ) "Catch of the Week" goes to Detroit Medical Center, Vanguard Health Systems, and Tenet Healthcare. On Wednesday, they agreed to pay roughly $30 million to settle government and whistleblower charges of violating the False Claims Act by providing kickbacks to certain referring physicians. It is just the latest in a string of False Claims Act settlements concerning kickbacks...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Vascular Surgeon Pays Over $60 Million for Defrauding Health Care Programs

Posted 05/26/23

This week's Department of Justice (DOJ) "Catch of the Week" goes to Michigan vascular surgeon Vasso Godiali. Yesterday, DOJ announced he was sentenced to 80 months in prison "for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of vascular stents and for thrombectomies that he did not perform." In addition to the jail time, Dr. Godiali also has to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

As States Look to Expand Health Coverage, State FCAs Become More Important than Ever

Posted 03/22/23

The increasing burden of healthcare costs has state governments looking at new programs to expand government healthcare options for their residents. Such an expansion of government spending will require a corresponding expansion of efforts to root out fraud, waste, and abuse that steals taxpayer dollars and reduces the benefits available. Existing anti-fraud measures, including state False Claims Acts, will play a...

Tagged in: FCA State, Government Programs Fraud, Healthcare Fraud, Medicaid, Medicare,

Healthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks

Posted 03/13/23

Very few cases ever filed reach jury trial. The vast majority are dismissed or settle long before that stage. This trend is particularly true for cases filed under the False Claims Act (FCA), where defendants face treble damages and penalties if they are found liable at trial. In FCA trials where the Government and/or whistleblower prevails, the judge, unbeknownst to the jury, is required to triple the amount of...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicare,

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District Court Rules that Broad Measure of Damages Applies in False Claims Act Case, Greatly Increasing Defendants’ Exposure

Catch of the Week: NextGen Healthcare

Beware of Salty Snacks and Candy Containing THC

Catch of the Week: National Health Care Fraud Sweep

Catch of the Week: Smart Pharmacy, Inc.

It's Medicare Fraud Prevention Week - What Can You Do?

Catch of the Week: Detroit Medical Center

Catch of the Week: Vascular Surgeon Pays Over $60 Million for Defrauding Health Care Programs

As States Look to Expand Health Coverage, State FCAs Become More Important than Ever

Healthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks

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