Takeaway: This recovery makes it very clear that the federal government and whistleblowers continue to aggressively pursue fraud allegations involving the Medicare Advantage Program. We can expect to see robust enforcement and sizable recoveries to continue.
On August 30, 2021, the United States Department of Justice announced a $90 million settlement with Sutter Health and certain of its affiliates (collectively Sutter Health) relating to allegations that Sutter Health had defrauded the federal government’s huge Medicare Advantage (Part C) Program.
- Individuals should be wary of the Speaker Programs they choose to attend. Simply attending a Speaker Program where alcohol or an expensive meal is served can be viewed as remuneration in violation of the AKS.
- HCPs should be extremely selective of the Speaker Programs they choose to participate in.
- The District of Massachusetts issued the very first summary judgment decision in a False Claims Act (FCA) lawsuit involving a private equity (PE) firm. The decision provides valuable insight into how the FCA may apply to PE firms.
- Equity and board control will remain relevant,
- January 18, 2021
- Construction, Defense Industry, Federal False Claims Act, Financial Industry, Government Contracts, Healthcare, Investigations, Medicaid, Medicare, Medicare Part D, Pharmaceuticals, Research, State False Claims Acts
- Over $300 million awarded to whistleblowers.
- Dip in recoveries reflects pandemic and economic challenges.
- Number of FCA filings hits a record.
- Healthcare continues to dominate FCA recoveries with kickbacks a major focus.
- Rebound in recoveries is likely as defendants regain financial footing.
On April 16, 2020, the Honorable William M. McSwain, United
States Attorney for the Eastern District of Pennsylvania, issued a sweeping
request for help in identifying companies and individuals who seek to “exploit
the devastating effects of the coronavirus pandemic for their own benefit.” The
Philadelphia United States Attorney’s Office has a long history fighting fraud.
On Sept. 27, the U.S. Department of Justice announced criminal charges against 35 individuals across various jurisdictions, allegedly involved in genetic testing fraud schemes that cost taxpayers over $2.1 billion.
The government asserted that the individuals had engaged in audacious schemes to target seniors and the disabled through the ordering of cancer genetic screening,
Member States of the European Union, over the last several years, have passed a series of so-called “Whistleblower Laws.” These laws are being implemented allegedly to bolster anti-corruption efforts throughout Europe. While corruption is no stranger to either side of the Atlantic,
The beat goes on…
According to a May 31, 2018 filing in New Jersey federal court, Dr. Thomas Savino of Staten Island was sentenced to four years imprisonment and three years’ supervised release, and was ordered to pay a $100,000 fine and forfeit $27,500 for his part in the Biodiagnostic Laboratory Services fraud.
On May 23, 2018, the U.S. District Court for the District of South Carolina, Judge Richard M. Gergel, imposed a $111 million judgment against former Health Diagnostics Laboratory (“HDL”) CEO, Latonya Mallory, and former BlueWave Healthcare Consultants (“BlueWave”) owners, Floyd Dent III and Robert Bradford Johnson.
In affirming the district court’s entry of summary judgment in favor of Accredo Health Group, Inc., and its co-defendants, the U.S. Court of Appeals for the Third Circuit held that a plaintiff alleging a False Claims Act (“FCA”) violation based on an anti-kickback theory must show that (1) a particular patient was exposed to a kickback-tainted referral,