The government has stated it is prepared to go after those who commit health care fraud to receive funds set aside to help deal with the coronavirus pandemic. True to its word, the Department of Justice (DOJ) has already reported one action against health care fraud...
Health Care Investigations
NY Governor Cuomo announces win against opioid manufacturer
The governor of New York recently announced another legal tool it will use in its fight against the current opioid epidemic. According to Gov. Andrew Cuomo, the state’s Department of Financial Services (DFS) has filed an insurance fraud action against one of the major...
Health care fraud in 2020: What will the feds investigate?
The United States Department of Justice (DOJ) recently announced the recovery of over $3 billion in False Claims Act (FCA) violations for health care fraud cases last year. Although this seems like a large number, it is in line with previous years. In fact, this is...
CMS to suspend some, reevaluate other, payment programs
Just a few weeks ago, the United States Centers for Medicare and Medicaid Service (CMS) announced it would allow certain health care providers to receive funds to help maintain financial footing during the coronavirus pandemic. To achieve this goal, the agency...
Labs: Consider these 3 things after recent EKRA conviction
In 2018, Congress enacted the Eliminating Kickbacks in Recover Act (EKRA). This law remains relatively untested. As such, labs can learn valuable lessons by watching court cases that are navigating this law.What led to the first EKRA conviction? The United States...
Why does the CMS’ now require disclosure of certain affiliations?
As noted in a previous post, CMS changes tactics, targets health care provider affiliates, the Centers for Medicare and Medicaid Services (CMS) has a new tool in its fight against health care fraud. The tool allows the agency to go after those who affiliate with...
CMS rule: A closer look at affiliation reporting for managers
As noted in a previous post, the Centers for Medicare and Medicaid Services (CMS) has a new rule that allows the agency to penalize those who fail to disclose affiliations with those who have had enrollment to Medicare or Medicaid previously revoked or denied.Medical...
NY pharmacy owner faces lifetime of prison for health care fraud
New York officials recently accused a local pharmacy owner of partaking in a health care fraud scheme that allegedly led to $2 billion in fraudulent claims to Medicare and Medicaid. According to the indictment, the government moved forward with criminal charges...
Theranos case an example of complex nature of health care crimes
The case against Theranos continues. Questions about the company, based in the health care industry and set to “revolutionize medical laboratory testing” with innovative blood draw and testing methods, began in 2015. Ultimately, investigations resulted in...
Rule gives CMS authority to act against affiliates of bad actors
The Centers for Medicare and Medicaid Services (CMS) have a new rule that allows a more proactive approach to enforcement efforts. Lawmakers wrote the rule to provide another tool against health care fraud. According to the Federal Register, the Program Integrity...

