The D.C. Circuit issued a ruling earlier this month giving CMS the authority to levy enormous fines against Medicare Advantage carriers for the submission of unsupported patient risk adjustment data to the federal government, laying the groundwork... Read More
Blogs & Articles | Life Sciences | Medicare Advantage Risk Adjustment Litigation | Pharmacy Law

In late July 2021, the Department of Justice announced that the federal government had decided to intervene in six pending False Claims Act (“FCA”) actions against Kaiser Permanente (“Kaiser”) for alleged Medicare Advantage risk adjustment... Read More
Blogs & Articles | Life Sciences | Medicare Advantage Risk Adjustment Litigation | Pharmacy Law | Value Based Care

In recent years, the federal government has markedly increased its efforts to target and combat health care fraud. One of the most powerful tools at the government’s disposal to effectuate this effort is the False Claims Act, a civil statute which... Read More
All types of single and multi-specialty medical practice groups | Blogs & Articles | Community, Retail Pharmacies | Healthcare | Healthcare Law | Pharmacy Law | White Collar Criminal Defense & Government Investigations

This spring, in United States v. Mallory, et al., the U.S. Court of Appeals for the Fourth Circuit upheld a $111 million verdict against LaTonya Mallory, the owner of a blood testing laboratory, Health Diagnostic Laboratory, Inc., (the... Read More
Blogs & Articles | Healthcare | Healthcare Law | Healthcare Practice Compliance | Laboratories | White Collar Defense and Government Investigation

Simply put a subpoena is a legal document that compels under penalty of law either testimony or the production of documents, records, and other tangible evidence. There are two primary forms of subpoenas: a subpoena for testimony, (ad testificandum)... Read More
Blogs & Articles | Healthcare | Healthcare Law | Pharmacy Law | White Collar Criminal Defense & Government Investigations | White Collar Defense and Government Investigation

On May 4, 2021, the Department of Justice announced that Incyte Corporation has agreed to pay $12.6 million to resolve allegations that it violated the False Claims Act by paying kickbacks through a non-profit organization. The Department alleged... Read More
Blogs & Articles | Life Sciences | Pharmacy Law | Regulatory Compliance, including FDA, DEA and HIPAA | White Collar Criminal Defense & Government Investigations

With the onset of the pandemic and the flood of claims submitted by providers to government payors in connection with it – such as claims for COVID testing or upwardly (risk) adjusted PMPM capitation payments – comes substantial risk for the... Read More
All types of single and multi-specialty medical practice groups | Blogs & Articles | COVID-19 Resources | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits

The United States Attorney’s Office for the District of Massachusetts recently settled a case against an otolaryngology practice and its management company involving improper billing for certain office visits and procedures. Medicare and... Read More
All types of single and multi-specialty medical practice groups | Blogs & Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | White Collar Defense and Government Investigation

False Claims Act (“FCA”) cases brought by the Department of Justice (“DOJ”) returned only $2.2 billion in recovered funds in 2020, down from $3.0 billion in 2019 and $2.9 billion in 2018, making 2020’s FCA recovery amount the lowest since... Read More
Blogs & Articles | Healthcare | Healthcare Law | White Collar Defense and Government Investigation

In a recent trend, the government is increasing investigations and prosecutions of pharmacies alleging health care fraud and False Claims Act (“FCA”) violations based on inventory shortages. Multiple governmental offices, including the... Read More
Blogs & Articles | Community, Retail Pharmacies | Federal and State Fraud and Abuse Counseling | Life Sciences | Pharmacy Law | White Collar Criminal Defense & Government Investigations