Healthcare Fraud and Abuse

During the fiscal year ending September 30, 2016, the federal government recovered $4.7 billion in fraud-related civil settlements and judgments, marking the twelfth straight year in which such recoveries exceeded $1 billion. Of these recoveries last year, $2.5 billion was related to matters involving false claims against the federal healthcare programs in violation of the False Claims Act (FCA). In addition to civil fraud recoveries, the Medicare Fraud Strike Force announced a number of high-profile criminal enforcement actions and results. In June 2016, the Strike Force announced its largest healthcare fraud takedown in its history, which involved charges against 301 individuals for approximately $900 million in false billings. Since 2011, national healthcare fraud takedowns by the Strike Force have resulted in charges against more than 1,200 individuals involving more than $3.5 billion in allegedly false or fraudulent billings.

This continued scrutiny makes it critically important for providers to pay close attention to legal developments concerning the FCA and related healthcare fraud and abuse statutes. The team of healthcare attorneys at Bass, Berry & Sims can help companies stay abreast of and understand how these developments can and will impact their business.

Our attorneys routinely represent healthcare providers faced with fraud and abuse enforcement actions by the government and litigation stemming from those enforcement efforts. From our base in Nashville, the nation’s healthcare capital, and our office in Washington, D.C., our healthcare attorneys understand the business and the politics of healthcare and the regulatory complexity and scrutiny that is faced by this highly regulated industry. Our attorneys bring the knowledge of having worked inside the government, providing great insight into how HHS-OIG, U.S. Department of Justice and the various State Attorneys’ General offices think about fraud and abuse in healthcare and the strategies they use to pursue these cases.

Our team of attorneys has represented healthcare clients in connection with internal investigations regarding potential regulatory, compliance and clinical issues. Our experience includes representing clients in investigations conducted by the Office of Inspector General, United States Department of Justice, the Centers for Disease Control and Prevention, the Office for Civil Rights and state regulatory agencies.

We provide healthcare clients with counsel and support for every sort of civil and criminal exposure, across all sectors of healthcare, including:

  • Alleged violations of various healthcare fraud and abuse laws such as the Stark Law and the Anti-Kickback Statute
  • Litigation arising under the False Claims Act
  • Alleged violations of the Food, Drug and Cosmetic Act
  • Medicare compliance, Medicaid compliance and audits (RAC audits, ZPIC audits)

For more information, visit the healthcare fraud practice page on the Bass, Berry & Sims website.

Procurement Fraud

Procurement fraud has emerged as one of the most frequently reported forms of economic crime. In response, the government has focused on identifying and prosecuting procurement-related violations, established the DOJ Procurement Fraud Task Force, strengthened statutory and regulatory tools, and increased the use of administrative actions like suspension and debarment.

The combination of regulatory complexity and heightened enforcement efforts present a growing challenge for contractors and companies that each year provide hundreds of billions of dollars in goods and services to governmental entities. Our attorneys are working at the forefront of these rapid developments, bringing our extensive public sector experience to bear to help our clients understand and mitigate the compliance risks associated with government procurement. Through training, strengthening compliance infrastructure and bolstering existing policies and procedures, Bass, Berry & Sims works with clients to reduce the likelihood of procurement violations.

Our procurement fraud counsel is based upon deep substantive experience with:

  • The Anti-Kickback Statute (AKS); False Claims Act (FCA), federally initiated or qui tam; Foreign Corrupt Practices Act (FCPA); Major Fraud Act and Procurement Integrity Act; and other legislation, regulations and rules.
  • Audit and compliance programs, mandatory disclosures, internal investigations, international trade and export controls, suspension and debarment proceedings and whistleblowers.

For more information, visit the procurement fraud practice page on the Bass, Berry & Sims website.