Compliance Trends

Labs Using New Legal Defense to Shoot Down FCA Lawsuits Over Unclear Regulations

Although the deliberate offenders tend to get all of the attention, many if not most billing, coding and reimbursement violations are committed by labs that want to comply with the rules but find them … [Read more...]

FALSE CLAIMS

Courts Create New Defense for False Claims Based on Reasonable Mistakes about Regulatory Requirements

The False Claims Act (FCA) bans labs and other providers from “knowingly” submitting false claims. “Knowingly” is a curious word. Medicare coverage and billing rules can be intricate, confusing and … [Read more...]

Enforcement Trends

Federal Courts Split on Government Dismissals of Qui Tam Claims

In 2018, the Justice Department (DOJ) ordered US Attorneys to aggressively seek dismissal of False Claims Act (FCA) whistleblower qui tam lawsuits that lack merit or don’t serve the government’s … [Read more...]

Enforcement Trends

Federal False Claims Act Recoveries Hit 5-Year High

For more than a decade, enforcement of the federal false claims act was a government cash cow. But in recent years, investment returns on the activity actually declined. That trend came to an end last … [Read more...]

Enforcement Trends

Federal Courts Split on Government Dismissals of Qui Tam Claims

In 2018, the Justice Department (DOJ) ordered US Attorneys to aggressively seek dismissal of False Claims Act (FCA) whistleblower qui tam lawsuits that lack merit or don’t serve the government’s … [Read more...]

Enforcement

Federal False Claims Act Enforcement Continues to Gather Steam

Despite the COVID-19 pandemic and continued sequestration of enforcement funds, federal false claims enforcement activity seems to be gathering momentum. Reversing recent trends, the federal Health … [Read more...]

Labs in Court

Self-Disclosing Saves Kentucky Lab Over $1 Million in False Claims Settlement

Case: A Kentucky-based lab that made heroic efforts to step up its COVID-19 testing early in the pandemic has agreed to shell $1.25 million for falsely billing Medicare, Medicaid, TRICARE and CHAMPVA … [Read more...]

Enforcement Trends

Federal Courts Split on Government Dismissals of Qui Tam Claims  

In 2018, the Justice Department (DOJ) ordered US Attorneys to aggressively seek dismissal of False Claims Act (FCA) whistleblower qui tam lawsuits that lack merit or don’t serve the government’s … [Read more...]

Enforcement

Fraud Recoveries Grow as Feds Target Telemedicine and COVID-19 Add-On Test Scams

Despite the COVID-19 pandemic and continued sequestration of enforcement funds, the federal Health Care Fraud and Abuse Control Program (Program) reversed recent trends and recovered more money in FY … [Read more...]

Labs in Court

University of Miami Settles Lab Testing False Claim Charges for $22 Million

Case: In this particular case, “The U” stands for unnecessary, as in medically unnecessary lab tests billed to Medicare by the University of Miami’s lab and off campus hospital-based facilities. The … [Read more...]


(-00000g2)