On August 15, 2017, the Secretary of Health and Human Services, Tom Price, issued a press release reporting that almost $105 million dollars will be bestowed upon 1,333 health centers across the United States, including its territories; and Washington D.C. Secretary Price stated “Americans deserve a healthcare system that’s affordable, accessible, of the highest quality,
Second Circuit Sets False Claims Act Pleading Standard For Claim Information
Last week, the Second Circuit held that a False Claims Act relator does not have to plead details of specific alleged false billings or invoices to the government, as long as he can allege facts leading to a strong inference that specific claims were submitted and that information about them are peculiarly within the defendant’s
Supreme Court Limitation on Forfeiture Will Impact Health Care Fraud Prosecutions
Health care fraud prosecutions in the Second Circuit and throughout the country have typically sought forfeiture money judgments against all defendants for the proceeds of the fraud obtained by all members of a health care fraud conspiracy. The Supreme Court recently curtailed these efforts in Honeycutt v. United States. In Honeycutt, the Court
Percentage-Based Billing Contracts Violate Medicaid Regulations and May Constitute Improper Fee-Splitting
The Medicaid Fraud Control Unit (MCFU) of the New York State Office of the Attorney General has recently issued restitution demand letters to providers for allegedly entering into percentage-based contracts with their billing agents. The MCFU letters cite the Medicaid Update March 2001, titled “A Message for Providers Using Service Agents” as follows:
“Implied Certification” Theory Allowed Under the False Claims Act
The Supreme Court recently allowed liability through the implied certification theory of the False Claims Act (FCA), which was raised and upheld in Universal Health Services, Inc. v. United States ex rel. Escobar. The decision provided for a new applicable standard and resolved the split among circuit courts on whether to recognize the theory.
Sixth Amendment Prevents Pretrial Restraint on Health Care Defendant’s Use of Untainted Funds To Pay Counsel
The Supreme Court held last week that in a federal health care fraud prosecution, the Sixth Amendment prevents the government from obtaining a pretrial freeze of assets that were untainted by the alleged crime and that defendant sought to use to pay her lawyer.
In Luis v. United States, the government alleged that the
‘Incident To’ Billing: Billing Physician as the Supervising Physician and Ancillary Personnel Requirements
CMS has published a Proposed Rule to clarify how physicians are to bill for services furnished “incident to” the professional services of a physician.
When a medical practice bills Medicare “incident to” for NPP services (i.e. “non-physician practitioners” such as nurses or physician assistants), the bill is rendered by the physician using the physician’s NPI
EDNY Judge Refuses To Unseal Grand Jury Minutes In Health Care Identity Theft Prosecution
Earlier this month, EDNY Judge Joanna Seybert examined the elements of Aggravated Identify Theft in an interesting context: a motion to unseal grand jury minutes in a health care fraud prosecution, United States v. Cwibeker.
Defendants were charged with billing Medicare for fictitious or non-compensable treatments of residents of assisted living facilities. Defendants would
Visiting Nurse Service Settles Some SDNY False Claims Act Allegations, Leaves Others Open As Part Of A “Remaining Investigation”
An interesting SDNY settlement agreement resolves some False Claims Act allegations, but leaves others for another day. Visiting Nurse Service of New York (VNS) paid just under $35 million to the United States and New York State to settle allegations that VNS improperly billed Medicaid for 1,740 members whose needs did not qualify for a
DOJ Criminal Chief Caldwell Outlines New Joint Criminal-Civil Qui Tam Process
Leslie Caldwell, DOJ Assistant Attorney General for the Criminal Division, spoke to the qui tam relators’ bar at a Taxpayers Against Fraud conference last month, stating a new DOJ policy for criminal and civil division coordination of qui tam cases, starting with intake.
Taxpayers Against Fraud is an organization of whistleblowers and their counsel, which