Department of Justice & HHS Announce Record Recoveries in 2011

On February 14, 2012, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) published a Report (a copy of which can be found here) touting recoveries of “[a]pproximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs” in fiscal year 2011. This announcement was accompanied by a […]

2011: The Year for Health Care Fraud Prosecutions

Federal prosecutions for health care fraud are on the rise.  Statistics gathered for a recent study show that the U.S. Department of Justice has already commenced 903 health care fraud prosecutions in 2011.  Last year, federal prosecutors launched a total of 731 such cases.  If this pace continues, 2011 will see an 85% increase in […]

Pitfalls of an Inventory Case in Criminal Prosecution

Two recent Medicaid and Medicare fraud prosecutions from the New York County District Attorney’s Office and the United States Attorney for the Eastern District of New York both allege that the defendant pharmacists and their respective pharmacies submitted false claims to Medicaid and Medicare for services not rendered.  That is, prescriptions were billed, but not […]

HIPAA-Based Criminal Indictment for Communicating with Patient’s Employer

A Virginia physician has become the first person criminally indicted under the Health Insurance Portability and Accountability Act (HIPAA) for communicating with a former patient’s employer. According to the United States Attorney for the Eastern District of Virginia, Dr. Richard Kaye, the former Medical Director of the Psychiatric Care Center at Sentara Obici Hospital in Suffolk, Virginia, […]

NY Court of Appeals: Legislature Must Amend Penal Law to Include Health Care Insurance Fraud

In a recent New York State decision, the Court of Appeals held that New York Penal Law 170.60, insurance fraud in the first degree, does not necessarily encompass a fraudulent health care insurance act.  In People v. Boothe, decided on February 24, 2011, the defendant CEO of a managed health care provider was indicted on […]