Health Care Fraud and The False Claims Act

• Negotiated False Claims Act settlement on behalf of Relator against large New York regional hospice based on allegations that the hospice fraudulently billed Medicare and Medicaid for medically unnecessary levels of care and falsely certified patients as terminally ill, and engaged in a retaliatory discharge of Relator for raising compliance concerns.
• Negotiated False Claims Act settlement on behalf of Relator against a large municipal hospital based on allegations that the hospital (1) fraudulently billed Medicare and Medicaid for podiatry hospital services and professional services in violation of program requirements relating to resident supervision and where some services were performed by residents who lacked legal authorization to participate in a graduate education program, and (2) sought reimbursement of graduation education program costs for a podiatry residency program that violated standard and was operated fraudulently
• Defended multiple medical providers, individual and corporate, against allegations and government investigations brought under the False Claims Act.
• Investigated Nichols Institute Diagnostics and its parent, laboratory giant Quest Diagnostics, under the False Claims Act and the Food, Drug and Cosmetic Act, based on allegations of quality issues affecting various blood tests, including those used to measured parathyroid hormone levels in dialysis and other patients.  Investigation led to a $302 million global settlement with the federal government, then one of the largest settlements ever obtained by the Department of Justice in a medical device case.
• Investigated Orphan Medical, Inc. and its parent Jazz Pharmaceuticals, Inc. under the False Claims Act and the Food, Drug and Cosmetic Act, based on allegations that Orphan Medical marketed the “date rape” drug GHB, under the brand name “Xyrem,” for medical uses not approved by the U.S. Food and Drug Administration.  Negotiated $20 million global settlement with Jazz Pharmaceuticals.
• Investigated global pharmaceutical manufacturers in relation to fraud allegations indicating possible violations of federal laws, including the Anti-Kickback Statute and Prescription Drug Marketing Act.
• Retained as expert by global device manufacturer to advise regarding impact of Anti-Kickback statute on certain contractual arrangements with physician consultant.
• Investigated and prosecuted multiple health care corporations and medical providers related to allegations of fraudulent billing practices.

Financial Fraud Investigations

• Investigated The Bank of New York for its involvement in the dissemination of fraudulent escrow agreements and failure to report evidence of criminal activity involving those agreements as required under the Bank Secrecy Act.  Investigation culminated in landmark agreement mandating sweeping reforms of the bank’s suspicious activity reporting and anti-money laundering procedures, ongoing reviews of the bank’s operations by an independent examiner and payment of $24 million.
• Investigated a Long Island-based mortgage bank and its employees for their involvement in a conspiracy to defraud the Department of Housing and Urban Development through fraudulent mortgage applications containing falsified employment and income data.
• Part of prosecution team that investigated Symbol Technologies, Inc. for its involvement in a massive accounting fraud.  Prosecuted Symbol’s former Director of Finance.
• Prosecuted attorney and multiple brokers for concealing exorbitant commissions earned on the sale of private placements formed to fund Hollywood film ventures.

Publications

• “False Claims Act Materiality Standard’s Odd Application to Payment Terms” (Law360, October 2020)
• “The Federal Anti-Kickback Statute and Safe Harbors” (Co-Author, American Bar Association, July 2020)
• “Federal Government Agrees to Global $260M Settlement with Florida Hospital Chain” (October 10, 2018)
• “OIG: Telehealth Equipment Donation Presents Low Risk of Fraud and Abuse” (September 19, 2018)
• “OIG Report Highlights Telehealth Reimbursement Challenges” (May 10, 2018)
• “OIG Report Reminds PT Service Providers to Review Billing Practices” (April 16, 2018)
• “Government Dismissal under the False Claims Act: Policy Change or Much Ado About Nothing?,” Westlaw Journal White Collar Crime (March 16, 2018)
• “Exploring Limits Of Anti-Kickback Law Employee Safe Harbor” (March 5, 2018)
• “2018 Bipartisan Budget Act and Stark Law Amendments” (February 21, 2018)
• “Deadline Fast-Approaching for Medicaid Managed Care Participating Providers” (November 7, 2017)
• “OIG Audit Discovers $51.6 M in Overpayments to Acute-Care Hospitals” (October 17, 2017)
• “Hidden Risks In Practice Acquisitions And Joint Ventures” (May 25, 2017)
• “OIG Releases Compliance Program Update” (April 18, 2017)
• “OIG Rejects Laboratory’s Offer to Provide Free Labeling to Dialysis Facilities” (March 10, 2017)
• “OIG Adds New Safe Harbor Protections in 2017” (January 24, 2017)
• “Five Essential Questions To Mitigate Corporate Compliance Risk” (November 18, 2016)
• “Safe Harbor, Safe Passage Under the Anti-Kickback Statute” (November 11, 2016)
• “False Claims Violations in a Post-Escobar World,” Corporate Compliance Insights (August 22, 2016)
• “Health Care Compliance: Tips For A Corporate Body Self-Exam” (July 14, 2016) |
• “Prosecutorial Discretion,” Nutrition Business Journal  in Nutrition Business Journal (March 7, 2016)
• “Hospital ‘Medical Necessity’ Settlements: An Abuse of the False Claims Act?” (November 23, 2015)
• “The Park Doctrine and the Perils of “Off-Label” Promotion” (September 30, 2015 )
• “DOJ Policy Memo Urges Prosecutors to Hold Individuals Accountable for Corporate Misdeeds” (September 17, 2015)
• “Potential Changes to the Stark Exceptions in New CMS Proposed Rule” (July 31, 2015)
• “New Payment Models Bring New Healthcare Data Measurement Requirements” (June 30, 2015)
• “Measuring Compliance Risk in Health Care Transactions” (February 10, 2014)
• “Fool’s Gold: How To Avoid Suspect Business Arrangements in Diagnostic Testing Ventures (November 30, 2013)
• “All That Glitters Is Not Gold: The Importance of Compliance Due Diligence In Assessing Healthcare Transaction Value” (September 30, 2013)
• “What does the Second Circuit’s Recent Decision in United States v. Caronia Not Say,” FDLI Food and Drug Policy Forum (February 13, 2013)
• “Due Diligence On Execs, Board Vital When Sizing Up Companies,” Fund Director Intelligence (December 20, 2012)
• “Risky business: Rx drugs obtained in the secondary market,” Drug Topics – Special Report (October 2012)
• “Combating Online Counterfeiting with Help from the Lanham Act,” Italy-America Chamber of Commerce, Inc. (December 2011)
• “Ensuring Product Integrity and Trust in Your Supply Chain,” Chief Executive.net (October 5, 2011)
• “Billing for drug overfill:  New compliance risk or old prohibition?,” HCCA Compliance Today(October 2011)
• “When The Government Knows Too Much For Its Own Good,” Law360 (September 9, 2011).
• “Health Care Compliance on a Shoestring,” HCCA Compliance Today.
• “Corporate Piracy Efforts: Cost Center or Profit Center?,” Law 360.
• “Reforming the Major Credit Rating Agencies: What Hath the SEC Wrought?,” The Metropolitan Corporate Counsel.
• “Overfill: A Drug Sample in Sheep’s Clothing?,” BNA Pharmaceutical Law & Industry Report.
• “The ‘Tone at the Top’: Can it Mitigate C-Suite Personal Liability?,” Food and Drug Law Journal.
• “Healthcare – Lessons From The U.S.,” Fraud Intelligence.
• “My Brother’s Keeper: The Rise of Independent Monitors,” The Early Warning System Report.
• Federal Government Agrees to Global $260M Settlement with Florida Hospital Chain (October 10, 2018)
• OIG: Telehealth Equipment Donation Presents Low Risk of Fraud and Abuse (September 19, 2018)
• OIG Report Highlights Telehealth Reimbursement Challenges (May 10, 2018)
• OIG Report Reminds PT Service Providers to Review Billing Practices (April 16, 2018)
• Government Dismissal under the False Claims Act: Policy Change or Much Ado About Nothing?, Westlaw Journal White Collar Crime (March 16, 2018)
• Exploring Limits Of Anti-Kickback Law Employee Safe Harbor (March 5, 2018)
• 2018 Bipartisan Budget Act and Stark Law Amendments (February 21, 2018)
• Deadline Fast-Approaching for Medicaid Managed Care Participating Providers (November 7, 2017)
• OIG Audit Discovers $51.6 M in Overpayments to Acute-Care Hospitals (October 17, 2017)
• Hidden Risks In Practice Acquisitions And Joint Ventures (May 25, 2017)
• OIG Releases Compliance Program Update (April 18, 2017)
• OIG Rejects Laboratory’s Offer to Provide Free Labeling to Dialysis Facilities (March 10, 2017)
• OIG Adds New Safe Harbor Protections in 2017 (January 24, 2017)
• Five Essential Questions To Mitigate Corporate Compliance Risk (November 18, 2016)
• Safe Harbor, Safe Passage Under the Anti-Kickback Statute (November 11, 2016)
• False Claims Violations in a Post-Escobar World, Corporate Compliance Insights (August 22, 2016)
• Health Care Compliance: Tips For A Corporate Body Self-Exam (July 14, 2016)
• Prosecutorial Discretion, Nutrition Business Journal  in Nutrition Business Journal (March 7, 2016)
• Hospital “Medical Necessity” Settlements: An Abuse of the False Claims Act? (November 23, 2015)
• The Park Doctrine and the Perils of “Off-Label” Promotion (September 30, 2015 )
• DOJ Policy Memo Urges Prosecutors to Hold Individuals Accountable for Corporate Misdeeds (September 17, 2015)
• Potential Changes to the Stark Exceptions in New CMS Proposed Rule (July 31, 2015)
• Health Services Alert (July 24, 2015)
• New Payment Models Bring New Healthcare Data Measurement Requirements (June 30, 2015)
• Measuring Compliance Risk in Health Care Transactions (February 10, 2014)
• Fool’s Gold: How To Avoid Suspect Business Arrangements in Diagnostic Testing Ventures (November 30, 2013)
• All That Glitters Is Not Gold: The Importance of Compliance Due Diligence In Assessing Healthcare Transaction Value (September 30, 2013)