Articles and Blogs

Earlier this week, the Department of Justice (“DOJ”) announced that the United States recovered over $5.6 billion from False Claims Act (“FCA”) cases in the federal fiscal year 2021, “the second largest annual total in False Claims Act history” and more than doubling the FCA recoveries for the DOJ from fiscal year 2020. Of... READ MORE

The Department of Justice (“DOJ”) recently announced that the United States recovered over $2.2 billion from False Claims Act (“FCA”) cases in the federal fiscal year 2020. While this is a decrease from the previous year’s recoveries, and likely related to the COVID-19 pandemic, the most recent figures are still on par with DOJ... READ MORE

Mergers and acquisitions in the health care industry present unique challenges that are not often present when undertaking similar transactions in other industries. Because of health care’s highly regulated nature, parties may falter if a health care transaction is not reviewed and negotiated carefully with respect to the distinct concerns that health care presents. ... READ MORE

Skilled nursing facilities (“SNFs”) are facing many challenges as their residents and staff encounter COVID-19 diagnosis, care and testing. During the COVID-19 pandemic, CMS and state departments of health have issued and revised interim final regulations, waivers, quality care directives, orders and multiple guidance memos. In early June 2020, the U.S. Department of Justice... READ MORE

On April 30, 2020, the Antitrust Division of the U.S. Department of Justice (the “DOJ”) announced its first criminal felony charge in an ongoing probe of the Florida cancer treatment industry. The DOJ alleged that from 1999 to 2016, Florida Cancer Specialists & Research Institute, LLC (“FCS”) and unnamed co-conspirators conspired to allocate the... READ MORE

The Office of the Inspector General (“OIG”) and Department of Justice (“DOJ”) often release information about compliance settlements under the Anti-Kickback Statute (“AKS”), including both the settlement value and the subject arrangement. The most recent data from 2018 shows several of these settlements arose from real estate arrangements and some involved millions of dollars... READ MORE

On April 30, 2019, the U.S. Department of Justice (“DOJ”) released an updated version of is guidance known as “The Evaluation of Corporate Compliance Programs” (“2019 Guidance Document”). This document provides actionable guidance for health care providers seeking to assess and enhance their compliance programs. The DOJ’s updates emphasize the government’s view that not... READ MORE

The DOJ plans to dismiss 11 FCA lawsuits involving the new theory that patient assistance services supplied by drugmakers are unlawful kickbacks.¹ These lawsuits were brought by shell company whistleblowers backed by the National Healthcare Analysis Group (“NHCA”), a company that specializes in generating FCA cases. The 11 cases were essentially the same complaints with a different... READ MORE

On September 17, 2018, the U.S. Department of Justice (“DOJ”) approved the $52 billion vertical merger between health insurer Cigna Corp. (“Cigna”) and pharmacy benefit manager (“PBM”) Express Scripts. The Cigna-Express Scripts merger is just one in a string of recent health insurer/PBM acquisitions. For more on these transactions, click here. As the largest unaffiliated... READ MORE

In November 2015, the Bipartisan Budget Act of 2015 went into effect. One aspect of that act was the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015. The new law required that the Program Fraud Civil Remedies Act and the False Claims Act (“FCA”) penalties be “corrected” to adjust for inflation since... READ MORE