HHS-OIG Issues Health Care Fraud and Abuse Control Program Report

By Sarah Wirskye - On

In October 2023, the HHS-OIG issued its annual report on the Health Care Fraud and Abuse Control Program for fiscal year 2022 (Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022 (hhs.gov). This comprehensive document delves into Program and Department of Justice (DOJ) activities, providing summaries of significant healthcare fraud …

Supreme Court Narrowly Interprets Aggravated Identity Theft Statute

By Sarah Wirskye - On

In Dubin v. United States, the Supreme Court unanimously held that Dubin did not violate 18 U.S.C.A. § 1028A, when he submitted a fraudulent claim to Medicaid using a patient’s name. In holding such, the Court stated that “Section 1028A(a)(1) is violated when the defendant’s misuse of another person’s means of identification is at …

Health Care Fraud Cases Continue to Dominate 2022 False Claims Act Recoveries

By Sarah Wirskye - On

Settlements and judgments under the False Claims Act (FCA) exceeded $2.2 billion in the fiscal year ending Sept. 30, 2022. Of the approximately $2.2 billion, over $1.7 billion involved the health care industry. This included recoveries from drug and medical device manufacturers, durable medical equipment, home health and managed care providers, hospitals, pharmacies, hospice …

Department of Justice Issues a New Memorandum Regarding Charging, Pleas and Sentencing

By Sarah Wirskye - On

In December 2022, Attorney General Merrick Garland issued a new Department of Justice (DOJ) charging, pleas, and sentencing policy memorandum (Policy). While the memorandum affirms the previous DOJ guidance in the Principles of Federal Prosecution (Principles), the new Policy provides for additional prosecutorial discretion in charging, plea agreements and the sentencing process. Charging Decisions …

United States Sentencing Commission Publishes The Organizational Sentencing Guidelines: Thirty Years of Innovation and Influence

By Sarah Wirskye - On

On August 29, 2022, the United States Sentencing Commission published The Organizational Sentencing Guidelines: Thirty Years of Innovation and Influence. The publication summarizes United States Sentencing Guidelines Chapter 8’s development and discusses the substantive changes to the elements of an effective compliance program. It also includes a snapshot of corporate sentencing over the last …

Department of Justice Announces Further Revisions to Corporate Criminal Enforcement Policies

By Sarah Wirskye - On

On September 15, 2022, the Deputy Attorney General Lisa Monaco announced the Department of Justice’s (DOJ) revisions to corporate criminal enforcement policies following discussions with the corporate crime advisory group. The policy changes focus on individual accountability, corporate accountability, monitorships, and transparency in corporate criminal enforcement. The policies in the memorandum will be incorporated …

OIG Issues Special Fraud Alert Regarding Telemedicine

By Sarah Wirskye - On

On July 20, 2022, the Department of Justice (DOJ) charged dozens of individuals for $1.2 billion in healthcare fraud violations. The cases focused on telemedicine, clinical laboratories, and durable medical equipment fraud. https://www.justice.gov/opa/pr/justice-department-charges-dozens-12-billion-health-care-fraud On the same day, the Office of Inspector General for the Department of Health and Human Services (HHS OIG) issued a …

Recent Fifth Circuit Rulings Regarding the Anti-Kickback (AKS) Statute

By Sarah Wirskye - On

In June 2022, the Fifth Circuit issued two decisions regarding the federal Anti-Kickback Statute (AKS), 42 U.S.C. 1320a-7b(b). The AKS criminalizes the knowing and willful payment of remunerations to induce referrals paid by federal healthcare programs. Remunerations is broadly defined to include anything of value. One opinion (Cooper) addressed self-referrals under subsection (2)(A) of …

Supreme Court Rules Prescriber Intent Matters under the Controlled Substances Act

By Sarah Wirskye - On

In Xiulu Ruan V. United States, No. 20–1410 (June 27, 2022), the Supreme Court ruled that under the Controlled Substances Act for prescribing of opioids and other addictive drugs, the government must show that doctors knew they lacked a legitimate medical purpose. In this case petitioner doctors Xiulu Ruan and Shakeel Kahn successfully appealed …