False Claims Act

The U.S. Department of Justice (DOJ) recently intervened in an action filed in Texas against two laboratory CEOs, one hospital CEO, and numerous other executives, employees, and recruiters, seeking civil penalties and treble damages for violations of the False Claims Act. The DOJ’s complaint, which was unsealed on April 4, also alleges that the fraudulent…

The U.S. Department of Justice (DOJ) announced on March 3 that Ameet Goyal, M.D., a Westchester-based ophthalmologist, was sentenced to 96 months in prison for falsely billing for millions of dollars of upcoded procedures over seven years, and for fraudulently obtaining two business loans under the CARES Act’s Paycheck Protection Program (PPP) in the early…

Rivkin Radler’s Michael Sirignano wrote an article, “The Opioid Crisis: An Epidemic Exacerbated by Fraud,” that appeared in the March 3 issue of the New York Law Journal. The article discussed the various types of opioid fraud, including illegal distribution, fake prescriptions, illegal dispensing by pharmacies, and medically unnecessary procedures.

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On Thursday, January 13, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler Partner Robert Hussar will present a review of key developments in healthcare fraud and abuse, compliance and government enforcement in 2021 as well as trends and changes in the industry that will impact healthcare organizations and…

Rivkin Radler’s Michael Sirignano wrote an article, “An Insurance Fraud Year in Review,” that was published in the January 6 issue of the New York Law Journal. Among the many cases and settlements discussed were False Claims Act cases involving federal healthcare programs, healthcare fraud related to COVID-19 testing and telehealth services,…

The U.S. Department of Justice (DOJ) announced that Flower Mound Hospital Partners LLC, a partially physician-owned hospital in Flower Mound, Texas, agreed to pay $18.2 million to settle its alleged violations of the False Claims Act (FCA). The DOJ alleged that the hospital knowingly violated the FCA by submitting claims to Medicaid, Medicare, and TRICARE…

On December 7, the U.S. Department of Justice (DOJ) announced that it had reached a Settlement Agreement with Princeton Pathology Services P.A., a New Jersey pathology practice, regarding Princeton Pathology’s alleged violations of the False Claims Act (FCA).

The DOJ contended that, from 2015 to 2020, Princeton Pathology submitted claims to Medicare under CPT code…

The Second Circuit, in United States ex rel. Foreman v. AECOM, No. 20-2756-cv, 2021 WL 5406437 (2d Cir. Nov. 19, 2021), addressed a question it had not previously decided, namely, whether disclosures made solely to the government are “public disclosures” sufficient to trigger the public disclosure bar under the False Claims Act (FCA).

The public…

On October 28, the Senate Committee on the Judiciary approved for consideration by the full Senate the False Claims Amendments Act of 2021 (“FCA-2021”). The primary sponsor of the bill (S. 2428) is Sen. Chuck Grassley (R-IA), and there are four cosponsors: Sen. Richard Durban (D-IL), Sen. John Kennedy (R-LA), Sen. Patrick Leahy (D-VT) and…

Rivkin Radler partners Evan Krinick and Michael Sirignano authored an article, “Compounding the Fraud: Questionable Billing by Pharmacies,” in the July 6 issue of the New York Law Journal. The article discussed the U.S. Department of Justice’s continued concern over fraudulent claims for reimbursement to federal healthcare programs for compounded prescription drugs.