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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,

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Top Ten Financial and Healthcare Fraud Prison Sentences of 2020

Posted  01/27/21
Hands in handcuffs behind back of white man in business suit
Individuals involved in financial and healthcare fraud schemes face not just civil liability, but also criminal penalties – including prison time. In 2020, the Department of Justice obtained substantial prison sentences in a myriad of cases involving healthcare and financial frauds, many of which involved convictions of the type of fraudulent schemes that whistleblowers report. Whistleblowers play an essential role...

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Pharma Fraud, Ponzi Schemes, Top 10,

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DOJ Reports Decline in Total Fraud Recoveries in 2020, but Whistleblower Efforts and Rewards Continue

Posted  01/14/21
Department of Justice building entrance
In its annual report of recoveries in fraud and False Claims Act cases, the Department of Justice reported total recoveries of $2.2 billion for the fiscal year ending September 2020.  These recoveries represent the lowest reported DOJ recoveries since 2008. While it is the decline in recoveries that stands out, the 2020 DOJ fraud statistics do share some things in common with prior years.  First, whistleblowers...

Tagged in: Defense Contract Fraud, FCA Federal, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Pharma Fraud, Statistics,

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Top Ten State Healthcare and Financial Fraud Recoveries of 2020

Posted  01/8/21
person raising the U.S. flag
State and local governments are on the front lines of enforcing anti-fraud laws and play a critical role in ensuring that businesses and individuals are held accountable.  Whistleblowers with information about corporate misconduct involving healthcare, government procurement, financial regulation, and tax may find that state proceedings offer them the best option. More than 30 states have False Claims Acts that...

Tagged in: Auto Safety, Drug and DME Pricing, FCA State, Financial and Investment Fraud, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Medical Billing Fraud, Pharma Fraud, Provider Fraud, Tax Fraud, Top 10,

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COVID Fraud: New York Pharmacy Owners Indicted on Charges Arising from their Abuse of Emergency Override Billing Codes

Posted  01/7/21
Flashing lights on top of police car
As we have previously written, regulatory changes designed to alleviate logistical and financial pressure on healthcare providers during the COVID-19 crisis, while necessary, can create opportunities for fraudsters.  Last month, an indictment in New York revealed a scheme by two pharmacy owners who took advantage of relaxed rules regarding prescription prior authorization and refill timing to overcharge Medicare and...

Tagged in: Catch of the Week, COVID-19, Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Pharma Fraud,

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Top Ten Healthcare Fraud Recoveries of 2020

Posted  01/5/21
Healthcare Fraud
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,

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Catch of the Week: 345 Charged in $6 Billion National Health Care Fraud and Opioid Takedown

Posted  10/2/20
Paper Ripped Uncovering Medical Necessity Wording
In the largest health care fraud and opioid enforcement action in the Justice Department’s history, 345 defendants—including more than 100 doctors, nurses, and other medical professionals—face charges for submitting over $6 billion in false or fraudulent claims to federal and private insurers.  Defendants stand accused of submitting $4.5 billion in fraudulent claims linked to telemedicine, $845 million...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Pharma Fraud, Provider Fraud,

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How Whistleblowers Can Report Fraud Related to Clinical Trials

Posted  09/4/20
Microscope
The COVID-19 pandemic has highlighted the importance of government-funded scientific and medical research, including clinical trials of vaccines, treatments, and more.  We are all potentially at risk if there is fraud and abuse in clinical trials and other research. Individuals with knowledge of fraud and misconduct in federal grants and clinical trials may be able to bring a whistleblower action for that research...

Tagged in: COVID-19, FCA Federal, FDA Fraud, Financial and Investment Fraud, Grant and Research Fraud, Healthcare Fraud, Pharma Fraud, SEC Whistleblower Reward Program, Securities Fraud, Whistleblower Answers,

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New Settlement Shows the Power of Whistleblowers to Root out Fraud against Private Insurers

Posted  08/6/20
whistle hanging against a chalkboard
The nation’s biggest insurers, Medicare, Medicaid, and TRICARE already incentivize whistleblowers to report fraud. Because those programs are federally-funded, a whistleblower can bring suit under the False Claims Act and share in 15-30% of the recovery. The FCA is a law that allows private individuals alleging fraud against the government to bring a lawsuit in the name of the United States. The law leads to about...

Tagged in: FCA Federal, Importance of Whistleblowers, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Whistleblower Case, Whistleblower Eligibility, Whistleblower Rewards,

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Catch of the Week: Indivior Agrees to Pay $600 Million to Settle Opioid Fraud Case

Posted  07/31/20
pill container spilled over with pills in the form of a dollar sign
The latest in our Catch of the Week series features Indivior Solutions’ (“Indivior”) agreement to pay $600 million to resolve criminal and civil liability associated with the marketing of the opioid-addiction-treatment drug Suboxone. This is in addition to the $1.4 billion resolution with Indivior’s former parent, Reckitt Benckiser Group PLC (“RB Group”) that was previously announced in 2019. Suboxone is a...

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

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