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Healthcare Fraud

3 Types of Qui Tam Off-Label Marketing Cases

1. Off-Label Marketing vs. Off-Label Prescribing The Food and Drug Administration ("FDA") requires that drugs be proven to be safe and effective for a particular use before they can be marketed. The FDA's approval is always limited to use or uses for which the manufacturer has submitted evidence of safety and efficacy. For example, if [...]

False Claims Actions May Rise Under Medicare Part D

A recently unsealed action brought under the False Claims Act is one of the first to allege claims related to Medicare Part D. Medicare contracts with private entities known as Part D sponsors to administer prescription drug plans. A sponsor may use subcontractors to obtain and provide the medications. Medicare  makes certain monthly payments based on [...]

Offer and Inducement Under the Anti-Kickback Statute

False claims attorneys must consider the federal Anti-Kickback Statute ("AKS") 42 U.S.C. § 1320a-7b(b) as a possible basis for a false claims action. This statute arose out of congressional concern that remuneration provided to those who can influence healthcare decisions would result in goods and services being provided that are medically unnecessary, of poor quality, or harmful to [...]

Off-Label Marketing as Misbranding in Federal False Claims Act Settlements

In recent years, the Department of Justice and qui tam plaintiffs have pursued a rash of claims involving misbranding of prescription drugs based on off-label marketing (where the drug manufacturer promotes a drug for uses not approved by the FDA or makes claims about the safety or efficacy of the drug that are not supported by the [...]

Sleep Labs and False Claims Act Violations

The American Academy of Sleep Medicine ("AASM") recognizes a number of different sleep disorders which, taken together, affect millions of Americans. Some of the most common disorders are insomnia, narcolepsy/excessive daytime sleepiness, restless leg syndrome, REM behavior disorders, and obstructive sleep apnea ("OSA"). In particular, OSA is when a patient's airways collapse during sleep [...]

Whistleblowing in Nursing

Nurses have long been a crucial part of the healthcare system, and they can be just as crucial when it comes to reporting fraud within that system. As insiders and observers of many healthcare procedures and billing practices, nurses have much-needed visibility into wrongdoing being committed by hospitals, physician-practice groups, drug manufacturers, home healthcare [...]

What is Medi-Cal Fraud?

Medi-Cal is the name of the State of California’s Medicaid program, as well as certain state healthcare programs. Medi-Cal is administered by the California Department of Health Services and accounts for more than $40 billion in annual expenditures - nearly one-quarter of the state's entire budget. Medi-Cal provides health coverage for approximately one out [...]

Medicare Fraud: Billing for Services Not Rendered

Imagine the following scenario: a patient with Medicare sprains her ankle and sees a doctor for one 15 minute appointment. The doctor then bills Medicare as if he had seen the patient for five 15 minute appointments over the course of a month. The doctor figures that Medicare will never notice, and this is [...]

What is the Medicare Fraud Strike Force?

Although fraud against the federal and state governments occurs in many different industries, there is always a lot of attention paid to healthcare fraud because it involves such enormous government expenditures, and it has such a huge impact on the beneficiaries of government healthcare programs. That impact can be through compromised healthcare or fraud [...]

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