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Catch of the Week: Dozens of Fraudsters Sentenced in Multimillion Dollar Compounding Pharmacy Fraud

Posted 04/30/21

On Thursday, an Alabama District Court Judge sentenced dozens of defendants to prison for participating in a massive conspiracy to swindle insurers for medically unnecessary compound drugs. The defendants included company executives and managers, a prescriber, billers, and sales representatives associated with Northside Pharmacy, which was doing business as Global Compounding Pharmacy (Global). According to the DOJ...

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

Bristol-Myers Squibb Settlement Highlights a Common-Sense Law: The Medicaid Drug Rebate Program

Posted 04/2/21

Drug prices are out of control. They now account for roughly 10% of our healthcare spending and America’s per capita outlay has nearly doubled over the past two decades. For the least fortunate among us, many of these medications have become out of reach altogether. While new proposals are regularly made, one approach that often gets overlooked is simply enforcing the laws already on the books. That is just...

Tagged in: Catch of the Week, Drug and DME Pricing, FCA Federal, Healthcare Fraud, Medicaid, Pharma Fraud, Whistleblower Case,

March Madness: AstraZeneca Fudges the Clinical Trial Results for Its COVID-19 Vaccine

Posted 03/26/21

In case you haven’t been following the NCAA Men’s Basketball Tournament (or even if you have), you might be surprised to learn that the University of Hartford is poised to win it all this year—except for the fact that it lost in the first round of the tournament to Baylor University, 79-55, and has been eliminated from the competition. Likewise, in case you haven’t been following the results of COVID-19...

Tagged in: COVID-19, FDA Fraud, Financial and Investment Fraud, Government Programs Fraud, Grant and Research Fraud, Healthcare Fraud, Pharma Fraud,

The False Claims Act: It Benefits More than Just the Government

Posted 03/5/21

The False Claims Act, a Civil War-era law, encourages private individuals, such as whistleblowers, to come forward and file suit against unscrupulous government contractors, and share in the government's recovery. The passage of the law was inspired by contractors selling the Union Army bags of sand as flour, lame mules as cavalry horses, and glued-together rags as uniforms. The main purpose of the law is, of...

Tagged in: Dosage Fraud, Environmental Fraud, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Prevailing Wage,

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,

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,

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

Posted 01/14/21

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,

Top Ten State Healthcare and Financial Fraud Recoveries of 2020

Posted 01/8/21

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,

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

Posted 01/7/21

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,

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,

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Catch of the Week: Dozens of Fraudsters Sentenced in Multimillion Dollar Compounding Pharmacy Fraud

Bristol-Myers Squibb Settlement Highlights a Common-Sense Law: The Medicaid Drug Rebate Program

March Madness: AstraZeneca Fudges the Clinical Trial Results for Its COVID-19 Vaccine

The False Claims Act: It Benefits More than Just the Government

DOJ Previews False Claims Act Enforcement Priorities for 2021

Top Ten Financial and Healthcare Fraud Prison Sentences of 2020

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

Top Ten State Healthcare and Financial Fraud Recoveries of 2020

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

Top Ten Healthcare Fraud Recoveries of 2020

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