In both civil and criminal enforcement proceedings, 2017 was perhaps most notable for the cases brought against individual health care providers and small physician practice owners. Among the factors that may have resulted in the uptick in cases against individuals are the Yates Memo issued in late 2015, improved and increased reliance on sophisticated data analytics, and the aggressive focus on opioid addiction and its causes. Continue Reading Health Care Enforcement Review and 2018 Outlook: Criminal and Civil Enforcement Trends
Eoin Beirne is a Member in the firm’s Boston office. Eóin is a litigator specializing in health care enforcement defense, white collar criminal investigations, and regulatory enforcement proceedings as well as corporate and securities litigation. He has conducted numerous internal investigations both at the client’s own initiative and following receipt of a subpoena or other notice of a government investigation in the areas of Foreign Corrupt Practices Act (FCPA) violations, health care fraud and abuse, insider trading and False Claims Act violations among others.
Continuing its annual tradition, the U.S. Department of Justice (“DOJ”) and the U.S. Department of Health and Human Services (“HHS”) announced last week the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force. As part of the national health care fraud takedown, the government charged 412 defendants with approximately $1.3 billion in alleged fraud. In addition to these charges, HHS Office of Inspector General (“OIG”) is in the process of excluding 295 health care providers from participating in federal health care programs.
Happy New Year! As we kick off 2017, our Health Care Enforcement Defense team brings you its annual review of key government policies, regulations, and enforcement actions in 2016, and the impact these trends are expected to have on enforcement in the year ahead. We start with a look at the Yates Memo and the uptick in the prosecution of individuals that has occurred since its publication. Stay tuned for the rest of our series and an invitation to our annual webinar, Health Care Enforcement Review & 2017 Outlook, on Wednesday, January 25 at 1:00 p.m. ET.
In the year since the Department of Justice (DOJ) issued what is known as the Yates Memo, we have already seen that it in fact dictated actual change in DOJ enforcement policy. While the long-held DOJ goal of charging individuals has not changed, the Yates Memo formalizes the requirement that federal prosecutors focus on identifying and pursuing potentially culpable individuals, and it establishes internal oversight mechanisms to ensure that they do. In support of that reinvigorated goal and as intended, according to Deputy Attorney General Yates, the Yates Memo has changed the behavior of companies that learn of potential wrongdoing. Companies have to make early and important decisions about how they conduct internal investigations, and they must quickly decide whether to disclose to the government – perhaps even before any conclusions are reached – to secure the greatest cooperation credit. Continue Reading Health Care Enforcement Review and 2017 Outlook: Yates Memo in Action
Like many before it, this year has been one to watch in government health care fraud enforcement efforts. In September 2015, the Department of Justice (DOJ) released the “Yates Memo,” which reaffirmed the government’s commitment to investigating and prosecuting culpable individuals in cases involving suspected corporate fraud. We discussed and analyzed the Yates Memo in greater depth in two September 2015 blog posts (click here and here) and in our Health Care Enforcement Defense Group’s 2015 Year in Review.
While the Yates Memo was not specific to health care companies, the health care industry was anxious to see how the government’s strong re-commitment to holding individuals accountable for corporate wrongdoing would play out given its aggressive pursuit of health care fraudsters. Perhaps the best known test case came when the government announced in October 2015 that it had arrested W. Carl Reichel, the former president of Warner Chilcott, a subsidiary of a pharmaceutical manufacturer. Reichel was indicted and charged with a single count of conspiring to pay kickbacks to physicians in violation of the Anti-Kickback Statute (AKS). Continue Reading Jury Acquits Former Pharma Exec in One of the First Post-Yates Memo Health Care Fraud Prosecutions
The U.S. Department of Justice (DOJ) issued a memorandum on Wednesday from Deputy Attorney General Sally Quillian Yates that reaffirms the Government’s commitment to prosecuting individuals and formally instructs prosecutors to focus on individual accountability when dealing with corporate misconduct. Yates delivered additional remarks yesterday on the memorandum and its expected impact on criminal and civil investigations of corporations. Having been publicly criticized for permitting corporations to take the fall and allowing individual wrongdoers off the hook, the DOJ has regularly tried to focus on individuals with only limited success. Some may view the memo as restating existing Government policy but it in fact represents a significant formal policy shift that almost requires prosecution of individuals in exchange for corporate cooperation credit.