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Criminal and Civil Penalties on the Rise with Healthcare Providers, Likely to Continue in 2017

In recent months, physicians, pharmacists, other healthcare providers have seen an unprecedented increase in criminal and civil penalties. Many of these missteps involve violations of the Anti-Kickback Statute (AKS), which is a criminal statute prohibiting individuals from knowingly and willfully soliciting or receiving remuneration in return for a referral for the furnishing of a drug or service for which payment may be made under a federal health care program. Oftentimes,...

Healthcare Fraud, Waste, and Abuse Concerns

The federal government has recently reported that, in FY 2016, False Claims Act suits resulted in a record breaking recoupment of $4.7 billion. However, penalties were not limited to civil recoupments; jail time, criminal forfeitures, and supervised release were also imposed on healthcare providers. In 2016, we saw an increase in governmental investigations, both in the civil and criminal realm, relating to physician practices, pharmacies, and healthcare marketing. The government...

DOJ Shows No Sign of Slowing Down, Evidenced Through Steep Recoveries and Expanding Investigations

The United States Government has continually and steadily ratcheted up its efforts in conducting False Claims Act (FCA) investigations, and seeking sizeable recovery amounts through both judgments and settlements. During the 2015 Fiscal Year (FY), the Department of Justice (DOJ) recovered $3.5 billion in settlements and judgments in civil cases involving fraud and false claims against the United States Government – $1.9 million of which was attributable to alleged FCA...

Catamaran Embarks on New Practice of Terminating Pharmacies Over Minor Audit Results

Pharmacy benefits managers have been auditing pharmacies for years, and have been seeking recoupment for perceived discrepancies. This concept is nothing new. However, Catamaran has recently engaged in practices expanding upon the traditional audit procedures and has embarked on a recent trend of terminating pharmacies for a whole host of reasons. Whether as a result of considerations as part of its recent merger with OptumRx or as a result of...

Federal False Claims Act Investigations are on the Rise: What Pharmacies and Healthcare Providers Need to Know When They Receive a Civil Investigative Demand

Over the past year, the United States Department of Justice (DOJ) has dramatically stepped up its efforts in investigating and prosecuting violations of the Federal False Claims Act. As part of this trend, the DOJ has recently begun stepping up its use of Civil Investigative Demands (CIDs) as one of its primary investigative tools in its campaign against violations of the False Claims Act. False Claims Act investigations and CIDs...