Medicare/Medicaid

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On September 9, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a major report (Report) regarding the fraud risks currently associated with skin substitute products billed to Medicare.Continue Reading HHS-OIG’s Latest Wound Care Report Warrants Careful Scrutiny

With the first half of 2025 in the rearview mirror, the government’s continued focus on False Claims Act (FCA) enforcement shows no signs of slowing. In fact, the Department of Justice recently announced the results of a record-setting National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants for alleged healthcare fraud schemes involving over $14.6 billion.Continue Reading False Claims Act Settlements to Know from the First Half of 2025

The False Claims Act (FCA) remains one of the government’s most powerful tools in combating healthcare fraud, with a growing focus on opioid-related cases and violations of the Anti-Kickback Statute. Continue Reading False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse Review

As federal contractors and grant recipients navigate the changing landscape of diversity, equity, and inclusion (DEI) programs, the Trump administration’s rescinding of Executive Order No. 11246 (EO) raises new concerns about potential False Claims Act (FCA) liability for non-compliance.Continue Reading Impact of Trump Administration’s Executive Order on DEI Programs and FCA Liability

The Trump administration’s recent executive order targeting diversity, equity, and inclusion (DEI) programs is reshaping the landscape for healthcare providers, with potential legal and regulatory implications that are still unfolding. Continue Reading Executive Order on DEI Programs: Implications for Healthcare and False Claims Act Risks

The Centers for Medicare & Medicaid Services (CMS) recently published updated data regarding settlements made under the Voluntary Self-Referral Disclosure Protocol (SRDP), an important mechanism through which providers may disclose actual or potential violations of the federal physician self-referral prohibition commonly known as the Stark Law. Continue Reading CMS Publishes New Data on Self-Referral Disclosure Protocol Settlements

In a recent decision, U.S. ex rel. Sibley v. Univ. of Chicago Medical Center, the U.S. Court of Appeals for the Seventh Circuit considered allegations that two medical billing and debt collection companies, Medical Business Office Corp. (MBO) and Trustmark Recovery Services, Inc. (Trustmark), and the University of Chicago Medical Center (UCMC), a client of one of the debt collection companies, violated the False Claims Act (FCA) by seeking inappropriate reimbursement from the Centers for Medicare and Medicaid Services (CMS) for Medicare “bad debts.”
Continue Reading Seventh Circuit Signals Ongoing Importance of Compliance with Medicare “Bad Debt” Regulations

I commented on the recent ruling by the Second Circuit Court of Appeals, which upheld the district court’s rejection of Pfizer’s argument that liability under the Anti-Kickback Statute requires an element of “corrupt” intent.
Continue Reading Court Decision Upholding OIG’s Rejection of Pharmaceutical Company’s Drug Co-Pay Assistance Program

I recently outlined healthcare-related fraud and abuse laws in Tennessee as part of Thomson Reuters’ Practical Law survey. My content focused on Tennessee is part of a series that examines state-by-state laws and regulations addressing civil and criminal actions, consequences for violation, and Medicaid program integrity provisions.
Continue Reading Tennessee Healthcare Fraud and Abuse Laws

From the Bass, Berry & Sims Blog Network
From the Bass, Berry & Sims Blog Network

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