Fraud & Abuse
Government enforcement efforts in the health care industry have increased dramatically in recent years and promise to continue that trend for the foreseeable future. First and foremost, Alston & Bird health care attorneys have the experience and the resources to ensure that your contracts, operations and key relationships are structured in a manner that minimizes the risks from federal and state fraud and abuse laws. In the event such allegations are raised, we can respond quickly to engage government officials and address the allegations proactively. Our team regularly advises on application of federal and state anti-kickback statutes, physician self-referral laws (including the federal Stark Law and state laws of similar import), restrictions on beneficiary inducements, federal and state False Claims Acts, and the federal Civil Monetary Penalties law.
Representative matters include the following:
- Obtained a favorable OIG Advisory Opinion related to a donation by a private hospital to a state university.
- Regularly conduct internal investigations related to potential violations of the fraud and abuse laws.
- Prepare, submit and negotiate voluntary self-disclosures to OIG, CMS and state attorney general offices.
- Provide advice to a wide range of health care providers with respect to proposed or existing arrangements, operations or affiliations.
- Defend against qui tam lawsuits alleging violations of fraud and abuse laws.
- Negotiate settlement agreements with government agencies over perceived areas of non-compliance.
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In the News August 18, 2022STAT+ | Pharma’s Likely to Sue over Medicare Negotiation. Here Are the Arguments They Might UseEmily Shaw is quoted on the potential legal challenges to Medicare drug price negotiation enacted in the Inflation Reduction Act.In the News August 18, 2022STAT+ | Pharma’s Likely to Sue over Medicare Negotiation. Here Are the Arguments They Might UseEmily Shaw is quoted on the potential legal challenges to Medicare drug price negotiation enacted in the Inflation Reduction Act.
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In the News July 20, 2021McKnight’s Long-Term Care News | Headed for the Provider Relief Fund Reporting Portal? Consider these Tips FirstBrian Lee is quoted on considerations for providers that must report on lost revenues and COVID-19 expenses as a condition for keeping CARES Act and Provider Relief Funds.In the News July 20, 2021McKnight’s Long-Term Care News | Headed for the Provider Relief Fund Reporting Portal? Consider these Tips FirstBrian Lee is quoted on considerations for providers that must report on lost revenues and COVID-19 expenses as a condition for keeping CARES Act and Provider Relief Funds.
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General Publications May-June 2021“Emerging Enforcement Issues Related to COVID-19 Relief Programs,” Journal of Health Care Compliance, Vol. 23, No. 3, May-June 2021.Since the beginning of the COVID-19 pandemic, the federal government has spent an unprecedented amount on disaster response. The large amount of funds coupled with the need to distribute the funds quickly has led to concerns about preventing and detecting fraud, both against the government and the public. This article discusses traditional compliance activities that can aid health care companies in mitigating risks associated with accepting and allocating funds.General Publications May-June 2021“Emerging Enforcement Issues Related to COVID-19 Relief Programs,” Journal of Health Care Compliance, Vol. 23, No. 3, May-June 2021.Since the beginning of the COVID-19 pandemic, the federal government has spent an unprecedented amount on disaster response. The large amount of funds coupled with the need to distribute the funds quickly has led to concerns about preventing and detecting fraud, both against the government and the public. This article discusses traditional compliance activities that can aid health care companies in mitigating risks associated with accepting and allocating funds.
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General Publications April 2021“Five Takeaways from the New Stark/Anti-Kickback Regulations,” Headnotes, Dallas Bar Association, Vol. 46, No. 4, April 2021.The Physician Self-Referral Law and federal Anti-Kickback Statute impact almost everything in the health care industry. These laws play a role in many health-care business arrangements, transactions, and government-enforcement actions. Late last year, the government updated its regulatory interpretation of these laws and published hundreds of pages of new guidance in the process. This article discusses five introductory takeaways of the government’s new regulatory interpretation of these statutes and how they may affect your practice or your clients’ businesses going forward.General Publications April 2021“Five Takeaways from the New Stark/Anti-Kickback Regulations,” Headnotes, Dallas Bar Association, Vol. 46, No. 4, April 2021.The Physician Self-Referral Law and federal Anti-Kickback Statute impact almost everything in the health care industry. These laws play a role in many health-care business arrangements, transactions, and government-enforcement actions. Late last year, the government updated its regulatory interpretation of these laws and published hundreds of pages of new guidance in the process. This article discusses five introductory takeaways of the government’s new regulatory interpretation of these statutes and how they may affect your practice or your clients’ businesses going forward.
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In the News October 21, 2020Virginia Law Weekly | Private Practice Careers in Health LawWade Miller is noted for participating in a panel hosted by the Health Law Association and shared her advice on starting a career in health law.In the News October 21, 2020Virginia Law Weekly | Private Practice Careers in Health LawWade Miller is noted for participating in a panel hosted by the Health Law Association and shared her advice on starting a career in health law.
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General Publications June 17, 2019“Government Contractor Compliance: 1 Size Can’t Fit All,” Law360, June 17, 2019.Companies that do business with U.S. federal, state and local government entities are no strangers to the plethora of obligations imposed on them by law, policy and contract. As U.S. government contractors expand beyond doing business with the federal government to contracting with state and local government entities, they are facing an interesting — and intensifying — predicament: How to develop a comprehensive yet straightforward compliance program that facilitates compliance with varying laws in varying jurisdictions.General Publications June 17, 2019“Government Contractor Compliance: 1 Size Can’t Fit All,” Law360, June 17, 2019.Companies that do business with U.S. federal, state and local government entities are no strangers to the plethora of obligations imposed on them by law, policy and contract. As U.S. government contractors expand beyond doing business with the federal government to contracting with state and local government entities, they are facing an interesting — and intensifying — predicament: How to develop a comprehensive yet straightforward compliance program that facilitates compliance with varying laws in varying jurisdictions.
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General Publications April 2019“Post-Acute Providers: Key Risk Areas and How to Minimize Them,” Compliance Today, April 2019.
Government enforcers continue to focus their efforts on post-acute providers. This article discusses recent government enforcement actions and key risk areas for hospice, home health, and skilled nursing facilities.
General Publications April 2019“Post-Acute Providers: Key Risk Areas and How to Minimize Them,” Compliance Today, April 2019.Government enforcers continue to focus their efforts on post-acute providers. This article discusses recent government enforcement actions and key risk areas for hospice, home health, and skilled nursing facilities.
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General Publications August 29, 2016“Don’t ‘Discount’ Gov’t Opinion on Anti-Kickback Exception,” Law360, August 29, 2016.On Aug. 24, 2016, the U.S. District Court for the District of Massachusetts issued an order allowing an ongoing False Claims Act/Anti-Kickback Statute (AKS) case, U.S. ex rel. Herman v. Coloplast Corp., No. 1:11-cv-12131 (D. Mass.), to move forward.General Publications August 29, 2016“Don’t ‘Discount’ Gov’t Opinion on Anti-Kickback Exception,” Law360, August 29, 2016.On Aug. 24, 2016, the U.S. District Court for the District of Massachusetts issued an order allowing an ongoing False Claims Act/Anti-Kickback Statute (AKS) case, U.S. ex rel. Herman v. Coloplast Corp., No. 1:11-cv-12131 (D. Mass.), to move forward.
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Advisories November 17, 2015Health Care / Health Care Litigation Advisory: U.S. v. AseraCare and the Standard of Falsity Under the False Claims ActOur Health Care and Health Care Litigation Groups examine the recent twist in the U.S. v. AseraCare False Claims Act case and its potential implications for providers.Advisories November 17, 2015Health Care / Health Care Litigation Advisory: U.S. v. AseraCare and the Standard of Falsity Under the False Claims ActOur Health Care and Health Care Litigation Groups examine the recent twist in the U.S. v. AseraCare False Claims Act case and its potential implications for providers.
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Advisories June 16, 2015Health Care Advisory: OIG Flags Physician Compensation Arrangements in Recent Fraud AlertThe U.S. Health and Human Services Office of Inspector General is increasingly scrutinizing physicians’ compensation arrangements that may run afoul of the federal Anti-Kickback Statute. Our Health Care Group prescribes conforming business practices that may avoid enforcement action.Advisories June 16, 2015Health Care Advisory: OIG Flags Physician Compensation Arrangements in Recent Fraud AlertThe U.S. Health and Human Services Office of Inspector General is increasingly scrutinizing physicians’ compensation arrangements that may run afoul of the federal Anti-Kickback Statute. Our Health Care Group prescribes conforming business practices that may avoid enforcement action.
Contacts