Category: Medicare
U.S. Justice Department Takes Tough Stance on MA Medicare Fraud in the Cases Against Kaiser Permanente
DOJ recently joined forces with numerous private plaintiffs against healthcare giant Kaiser Permanente. The original whistleblower lawsuit, filed under the qui tam provisions of the False Claims...
The Inspector General’s Strategic Plan for 2020-2025
In addition to fighting fraud, HHS-OIG performs a myriad of other functions that are worth mentioning. In its Strategic Plan for 2025, it articulated a...
OIG Is the Fulcrum in the Fight Against HSS Program Fraud
The U.S. Department of Health and Human Services (HSS) provides over $1 trillion in health and human services to the American people. Every day, more...
Paying Physicians to Draw Blood and Process Samples Can Be an Illegal Kickback – U.S. V. Mallory
In U.S. v. Mallory, the 4th Circuit Court of Appeals issued a recent opinion regarding violations of the Federal Anti-Kickback Statute and involving Medicare Fraud. ...
Healthcare Fraud Risk Framework
Healthcare Fraud can take multiple forms. The quintessential Healthcare Fraud schemes include fraudulent billing for services not provided, billing for services provided but were not...
What Does “Materiality” and “Scienter” Have to Do With the False Claims Act?
A Falsehood Must be Material to be Actionable If a falsehood did not have any impact on whether the government decided to pay a benefit,...
FDA APPROVES FIRST DRUG TO TREAT ALZHEIMER’S IN 17 YEARS
On June 7th, 2021, the FDA approved Biogen’s Aduhelm (aducanumab) for the treatment of Alzheimer’s disease, the first drug approved to treat Alzheimer’s in 17...
What is the Daubert Standard as it Relates to Expert Testimony?
Why Do We Sometimes Need Expert Witnesses to Resolve Legal Disputes? The standard legal reason that judges typically give to juries as to why an...
When is Expert Testimony Considered “Rebuttal” Testimony?
United States ex rel. Montcrieff v. Peripheral Vascular Associates – Part II In this blog post, we review one of the issues in Montcrieff: the...