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Recognizing ‘Worthless Services’ Under the False Claims Act

When it comes to committing fraud against Medicare and Medicaid, there are a number of ways for doctors, hospitals, and medical companies to get around the rules. Some encourage billing specialists to “upcode” for higher reimbursement rates, essentially billing Medicare or Medicaid for services never rendered. Others, quite alarmingly, perform […]

DOJ’s Motion to Reopen PharMerica Whistleblower Case Highlights Critical FCA Issues

False Claims Act cases often conclude with a negotiated settlement between the Department of Justice (DOJ), defendant(s), and the relator(s). However, settlements are complex matters that contain a number of terms and provisions unique to each individual case.

SEC Settles Fraud Case Regarding Restrictive Language With KBR, Inc.

Whistleblowers with knowledge of possible securities fraud are able to report this fraud confidentially under the relatively new whistleblower provisions of the 2010 Dodd Frank Act. If an employee opts to report the information directly to the government, he or she is thereafter protected from retaliatory maneuvers by the employer […]

Off-Label Marketing Becomes Global Issue as World Health Organization Encourages Cost-Effectiveness

Amid global shortages of life-saving medical resources, the United Nations’ World Health Organization has released a report focusing on various cost-saving tactics for member nations to consider while strategizing medical policy. At the heart of the matter, the WHO found that most nations do not have procedures in place to […]

Department of Education Yanks Funding From Several ‘Risky’ Colleges and Universities

Over the past several years, a number of colleges and universities have faced significant fines, penalties, and liabilities for unlawfully inducing students into enrolling using falsified or exaggerated graduation and employment data or by paying recruiters by the enrollee. For instance, several U.S. law schools were named in a recent […]