Articles and Blogs

On September 2, 2022, the Office of the Inspector General (“OIG”) published a study assessing potential Medicare program integrity risks related to the proliferation of telehealth services during the first year of the COVID-19 pandemic. OIG identified 1,714 providers with billing practices deemed “high risk” to the Medicare program. These providers billed approximately 500,000... READ MORE

Mergers and acquisitions in the health care industry present unique challenges that are not often present when undertaking similar transactions in other industries. Because of health care’s highly regulated nature, parties may falter if a health care transaction is not reviewed and negotiated carefully with respect to the distinct concerns that health care presents. ... READ MORE

On June 19, 2020, the Department of Justice (the “DOJ”) announced its Final Rule[1] increasing the penalties assessable under the False Claims Act (“FCA”). The DOJ raised the minimum penalty for a single false claim from $11,181 to $11,665; the maximum penalty from $22,363 to $23,331. Under the False Claims Act,[2] any person who... READ MORE

Skilled nursing facilities (“SNFs”) are facing many challenges as their residents and staff encounter COVID-19 diagnosis, care and testing. During the COVID-19 pandemic, CMS and state departments of health have issued and revised interim final regulations, waivers, quality care directives, orders and multiple guidance memos. In early June 2020, the U.S. Department of Justice... READ MORE

On April 30, 2020, the Antitrust Division of the U.S. Department of Justice (the “DOJ”) announced its first criminal felony charge in an ongoing probe of the Florida cancer treatment industry. The DOJ alleged that from 1999 to 2016, Florida Cancer Specialists & Research Institute, LLC (“FCS”) and unnamed co-conspirators conspired to allocate the... READ MORE

On March 24, 2020, the Federal Trade Commission (the “FTC”) and the Antitrust Division of the Department of Justice (the “DOJ”) issued a joint statement offering an insight into the Agencies’ approach to the COVID-19 pandemic and how entities can engage in pro-competitive collaboration that does not violate the antitrust laws. While much of... READ MORE

The Office of the Inspector General (“OIG”) and Department of Justice (“DOJ”) often release information about compliance settlements under the Anti-Kickback Statute (“AKS”), including both the settlement value and the subject arrangement. The most recent data from 2018 shows several of these settlements arose from real estate arrangements and some involved millions of dollars... READ MORE

The DOJ’s recent revisions to its Justice Manual created a new path for self-disclosing potential fraud to the government – one which is unique in its ability to defray the costs of potential False Claims Act violations. In 2015, Deputy Attorney General Sally Quillian Yates released a memo entitled Individual Accountability for Corporate Wrongdoing, more... READ MORE

On April 30, 2019, the U.S. Department of Justice (“DOJ”) released an updated version of is guidance known as “The Evaluation of Corporate Compliance Programs” (“2019 Guidance Document”). This document provides actionable guidance for health care providers seeking to assess and enhance their compliance programs. The DOJ’s updates emphasize the government’s view that not... READ MORE

The U.S. government’s unilateral investigative powers under the False Claims Act were bolstered by a ruling from the U.S. District Court for the Eastern District of California last week. Ruling on a Petition for Summary Enforcement of a Civil Investigative Demand (“CID”), the court held: Settlement discussions with a person or entity involved in... READ MORE