Though there are significant aggravating factors including identity theft, going to trial, etc., a striking fact about this case is that the total collections in this case were under $1 million but the defendant was sentenced to 121 months. This also appears to be a classic example of the type of ...

A common side effect of settling a health care related criminal accusation is the potential for “exclusion.” Exclusion means that the provider cannot provide any services that will be paid for by federal funds, which effectively means that the provider cannot work for a facility that sees Medicare or Medicaid ...

The U.S. Attorney’s Office in Los Angeles filed a plea agreement Thursday in which Dr. Andrew Sun pled guilty to drug trafficking for prescribing hydrocodone (Vicodin), Soma, and Xanax. This is just one of many such cases and it appears to have been pursued in the usual way, i.e., a ...

The Second Circuit Court of Appeals just issued an important decision that limits the government’s ability to retain non-responsive computer files after executing a search warrant. Assume the government obtains a search warrant for a clinic’s electronic medical records. On the same computer, the doctor maintains her financial information. Because ...

According to a political website, a Chief Regional Counsel predicted that HIPAA fines will increase in the coming year, stating this was based on the number of matters in HHS’s pipeline. Consistent with the saying “The cobbler’s children go unshod,” HHS could probably increase that number substantially if they also audited ...

Recoveries were down last year, but still quite significant. Could it be that the “low hanging fruit” is already gone? Or, could it be that it’s just a natural variation. Nevertheless, this is probably not an indicator that there’s less fraud. To read the USDOJ’s full press release, click here.