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

The long-running test-referral prosecution against Biodiagnostic Laboratory Services, LLC (“BLS”), a New Jersey clinical blood testing laboratory; its owner and employees; and BLS’s referring physicians recently reached another milestone. In a criminal case that the U.S. Attorney’s Office for the District of New Jersey has called the “largest physician bribery case ever prosecuted,” resulting in 40 guilty pleas, BLS was sentenced on June 28, 2016 and ordered to forfeit all of its assets.

In addition, on June 30, 2016, the 27th BLS referring physician pleaded guilty to charges that he violated the Federal Travel Act by taking bribes from BLS. The physician admitted that, between April 2011 and June 2012, BLS paid him approximately $1,500 per month. This physician plea is another in the long line of individual criminal pleas, 38 of which are catalogued here. Continue Reading Biodiagnostic Laboratory Services Sentenced; Another Physician Pleads Guilty

Mintz Levin’s Health Care Enforcement Defense Group has issued a new Client Advisory:  Industry Trends in Criminal Health Care Fraud Enforcement – Part III in a Continuing Series on Health Care Enforcement.   Written by Hope Foster, Tracy Miner, Stephanie Willis, Samantha Kingsbury, and Brian Dunphy, this third and final installment reviewing criminal health care fraud enforcement activities in 2011 and anticipating trends in 2012, expands upon the overview of criminal enforcement tools and strategies provided in the Part One Report.  To complement our analysis of civil health care fraud enforcement through the use of the FCA in the Part Two Report, Part Three provides the highlights of enforcement in the DME, home health, and therapy/clinic-related industries and also examines the expanded use of non-health-care fraud-related statutes and traditionally “blue-collar” crime strategies to prosecute alleged fraud involving government health care programs.  Finally, it considers how recent health care reform measures, such as new regulations, enhanced sentencing guidelines, and data analysis technology, will contribute to strengthened enforcement in 2012.

With these three introductory pieces, the Health Care Enforcement Defense Group will now publish quarterly updates to help keep clients informed of new trends and hot topics in civil and criminal health care fraud enforcement.