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Top Ten False Claims Act Recoveries in 2023

Posted 01/11/24

It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

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

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,

Top Ten Healthcare Fraud Recoveries of 2022

Posted 01/6/23

Healthcare fraud image showing stethoscope with gavel

Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

DOJ Previews False Claims Act Enforcement Priorities for 2021

Posted 03/5/21

Department of Justice Seal on the United States Flag

The False Claims Act is the federal government's primary enforcement tool to combat fraud against the public. Every year the government recovers billions of dollars under the statute, primarily with the help of whistleblowers. Under the so-called qui tam provisions of the act, whistleblowers are authorized to act as private attorneys general and bring lawsuits on behalf of the government and recover a portion of...

Tagged in: COVID-19, Cybersecurity and Data Breaches, Electronic Health Records, FCA Federal, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Pharma Fraud, SNF,

Catch of the Week: EHR Vendor Athenahealth Settles Kickback Cases Brought by Whistleblowers

Posted 01/29/21

Computer screen showing electronic medical records system with ICD 10 codes

Athenahealth Inc. agreed to pay $18.25 million to resolve allegations that the electronic health records company violated the False Claims Act by paying unlawful kickbacks to potential customers and others. The government’s investigation was prompted by two whistleblower actions filed in 2017; the actions were consolidated and the government filed a complaint in intervention immediately prior to the...

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

Top Ten Healthcare Fraud Recoveries of 2020

Posted 01/5/21

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, FCPA, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

Posted 08/28/20

Law360 recently interviewed former DOJ Civil Chief Jody Hunt on what he sees as the key issues surrounding False Claims Act enforcement these days. Here are the top takeaways:

- COVID-relief fraud will be a DOJ priority. No surprise there given the billions of dollars the federal government is pouring into the economy to alleviate some of the financial strain the pandemic is wreaking on healthcare providers...

Tagged in: Anti-Kickback and Stark, COVID-19, Electronic Health Records, FCA Federal, Government Loan Programs, Home Health and Hospice, Importance of Whistleblowers, Risk Adjustment Fraud, Whistleblower Eligibility,

DOJ Discusses Its 2020 Healthcare Fraud Enforcement Priorities

Posted 03/6/20

DOJ Headquarters building seen from low angle

In comments at the 2020 FBA Qui Tam conference, the Department of Justice reaffirmed its strong commitment to pursuing fraud under the False Claims Act and emphasized its particular focus on rooting out healthcare fraud. Jody Hunt, Assistant Attorney General in the Civil Division of DOJ, was encouragingly forceful in his comments about the critical role of the FCA in protecting the public fisc—and the patient...

Tagged in: Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Risk Adjustment Fraud,

Catch of the Week: Practice Fusion Pays $145 Million for EHR Kickbacks and Misrepresentations about Software

Posted 01/28/20

Healthcare providers talk about the importance of behavioral “nudges” – gentle pushes to encourage healthy choices and positive behaviors. In our Catch of the Week, healthcare providers were nudged to prescribe highly addictive extended-release opioids in a manner that was not consistent with accepted medical standards. Who nudged them? Their own electronic health records system, which was paid to do so by the...

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

Top Ten Healthcare Fraud Recoveries of 2019

Posted 01/24/20

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

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Top Ten False Claims Act Recoveries in 2023

Catch of the Week: NextGen Healthcare

Top Ten Healthcare Fraud Recoveries of 2022

DOJ Previews False Claims Act Enforcement Priorities for 2021

Catch of the Week: EHR Vendor Athenahealth Settles Kickback Cases Brought by Whistleblowers

Top Ten Healthcare Fraud Recoveries of 2020

Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

DOJ Discusses Its 2020 Healthcare Fraud Enforcement Priorities

Catch of the Week: Practice Fusion Pays $145 Million for EHR Kickbacks and Misrepresentations about Software

Top Ten Healthcare Fraud Recoveries of 2019

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