Feds File False Claims Act Lawsuit Against UnitedHealth Group

Is it the government’s “murky policies,” as suggested by a UnitedHealth spokesman, or was it outright fraud that led to allegations the healthcare insurance giant engaged in fraud? That’s a question that will have to be answered following the U.S. Department of Justice’s recent decision to intervene and file a complaint against UnitedHealth Group (UHG). […]

The Health Law Offices of Anthony C. Vitale Scores Major Win Against Life Care Centers of America

$145M landmark settlement largest in DOJ history involving skilled nursing facility Oct. 26, 2016 (MIAMI, FLA.) It was a case that was eight years in the making, but on October 24, Anthony C. Vitale’s hard work and dedication paid off when Life Care Centers of America Inc., and its owner Forrest L. Preston, agreed to […]

Feds step-up crackdown on fraudulent billing for compounded meds

The recent indictment of a St. Petersburg physician who was charged with receiving illegal kickbacks for writing prescriptions for compounded medications serves to further highlight the federal government’s increased level of scrutiny over the industry. The facts of the latest case are as follows: Dr. Anthony Baldizzi was charged on June 23 with one count […]

Report: HHS OIG fraud recoveries on the rise

The Department of Health and Human Services Office of the Inspector General recently released its semi-annual Report to Congress outlining its anti-fraud activities. The report highlights OIG’s accomplishments for the six-month period ending March 31, 2016. The agency noted that during that period it reported expected recoveries of more than $2.77 billion consisting of nearly […]

SCOTUS Hears Arguments on Implied Certification Theory

Last month, the United States Supreme Court took up the issue of whether False Claims Act (FCA) cases may be brought by whistleblowers and the government under the theory known as “implied certification.” And, if so, under what circumstances. On April 19, the high court heard oral arguments in Universal Health Services v. United States […]

Healthcare Fraud and Abuse Crackdown Not Slowing as Evidenced by Recent Cases

The federal government has been busy since the beginning of the year announcing arrests, convictions and settlements relating to healthcare fraud and abuse. The activities relate to violations of the Stark Law, anti-kickback law and federal False Claims Act, and there appears to be no end in sight. Whether it’s home health, transportation, durable medical […]

Lessons learned from whistleblower FCA case against cancer treatment company

Earlier this month, the U.S. Department of Justice announced that 21st Century Oncology and its wholly owned subsidiary, South Florida Radiation Oncology LLC, agreed to settle False Claims Act allegations relating to billing for procedures that were medically unnecessary. Specifically, the Fort Myers, Florida-based company was alleged to have billed for performing the Gamma function […]

CMS clarifies 60-day overpayment rule

The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule that details the reporting and returning of Medicare Part A and B overpayments. The proposed rule left providers asking many questions. The final rule provides needed clarity and consistency in the reporting and returning of self-identified overpayments. It is designed to […]

SCOTUS to take on implied certification liability under FCA

The U.S. Supreme Court will decide whether False Claims Act (FCA) cases may be brought by whistleblowers and the government under the theory known as “implied certification” and if so, under what circumstances. Under this theory, when a provider submits a claim for government payment, it does so with the implication that it is being […]

Feds to increase exclusion and civil monetary penalty enforcement cases

When it comes to exclusion and civil monetary penalty cases, the federal government is preparing to take an even harder line than in the past. During the recent Health Care Compliance Association’s Healthcare Enforcement Compliance Institute, Gregory Demske, chief counsel at the Health and Human Services Office of Inspector General, told an audience his agency […]