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
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
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 …
Fifth Circuit Requires Law Firm to Produce Client Names in Response to IRS Summons
In Taylor Lohmeyer Law Firm P.L.L.C. v. United States, 957 F.3d 505 (2020), the Fifth Circuit affirmed the district court’s ruling that a law firm’s clients’ names were not protected by the attorney client privilege. Taylor Lohmeyer, a Texas law firm, filed an action to quash an IRS John Doe summons. The IRS had …
Department of Justice Announces Coordinated Law Enforcement Action to Combat Healthcare-Related Covid Fraud
The Department of Justice (DOJ) announced a nationwide coordinated law enforcement action to combat healthcare-related covid fraud. On April 21, 2022, the DOJ announced criminal charges against 21 defendants in nine federal districts across the United States for their alleged participation in various health care related fraud schemes that exploited the COVID-19 pandemic. These …
Defense Victories Regarding the Knowledge Requirement under the False Claims Act
The False Claims Act (31 U.S.C. §§3729-3733; “FCA”) imposes liability on persons and companies who defraud the government. Last year, DOJ recovered more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government. Notably, of the over $5.6 billion recovered, over $5 billion involved the health …
Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) releases Solutions to Reduce Fraud, Waste and Abuse in HHS Programs
The U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) released its annual Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: OIG’s Top Unimplemented Recommendations. The OIG directed most of its recommendations to CMS to help “reduce improper payments, prevent and deter fraud, and foster economical payment policies.” Specific …
Department of Justice Publishes FY 2021 False Claims Act Data
The Department of Justice (DOJ) published fiscal year 2021 False Claims Act data. The False Claims Act (31 U.S.C. §§3729-3733) (“FCA”) imposes liability on persons and companies who defraud the government. It is the federal government’s primary tool in combating fraud against the Government. https://wirskyelawfirm.com/false-claims-act-basics/. The DOJ recovered more than $5.6 billion in settlements …
What to Expect in Healthcare Fraud Prosecutions in 2022
The government’s focus on healthcare fraud and abuse continued in 2021. Even stronger enforcement is expected by Biden’s new Secretary of Health and Human Services Xavier Becerra, who previously served as California’s Attorney General. The following trends seen in 2021 are expected to continue in 2022. Kickbacks and Referral Arrangements. The government’s focus on …
Biden Administration Unveils United States’ Strategy on Countering Corruption
In December 2021, the Biden administration released the United States Strategy on Countering Corruption (“Strategy”). Htttps://www.whitehouse.gov/wp-content/uploads/2021/12/United-States-Strategy-on-Countering-Corruption.pdf. The Strategy follows up on establishing the fight against corruption as a core national security interest of the United States in the National Security Study Memorandum-1 (NSSM-1) earlier in 2021. The Strategy discusses the impacts of corruption and …