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May 22, 2017 Healthcare Fraud

Are There “Special” Frauds Involving Specialty Drugs? Part II

In Part I of this blog series, we defined the term “specialty drugs” and addressed whether fraud is common in the specialty drugs arena. In this blog post, we will examine how the federal Anti-Kickback Statute impacts specialty drug fraud, whether there are special frauds involving specialty drugs, and what […]
May 19, 2017 Healthcare Fraud

Are There “Special” Frauds Involving Specialty Drugs? Part I

If you work in an industry involving pharmaceuticals, whether as a drug sales rep, a PBM employee or a direct healthcare provider, you’ve probably heard a lot about specialty drugs.  But what exactly are they?  Is fraud common in this area?  How do you know if your employer is playing […]
March 24, 2017 Healthcare Fraud

The Federal Anti-Kickback Statute

The federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), (“AKS”) 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 a vulnerable patient population. To protect the integrity […]
March 8, 2017 Healthcare Fraud

Whistleblower Lawsuits Against Medicare Advantage Organizations

In addition to the big qui tam case against UnitedHealth Group that has received so much press recently, there is a similar whistleblower case pending in federal court in Texas alleging False Claims Act (“FCA”) claims against a medical coding company, Censeo Health, L.L.C., and several Medicare Advantage organizations (“MAOs”).   […]
March 1, 2017 Healthcare Fraud

Laboratories May be Liable under the False Claims Act for Submitting Claims for Screening Tests to Medicare

Laboratory tests are not medically necessary when they do not “determine a disease or illness. . . or medically or surgically manage an illness.” Strand Analytical Labs., LLC v. Burwell, 2015 WL 4603258, at *17 (S.D. Ind. July 30, 2015) (“The plain meaning of the words diagnose and treat do […]
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