Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
Laboratory Kickback Enforcement: Process and Handling Fees
Specimen processing fees look like overhead reimbursement, but the OIG's 2014 alert and $48.5M in DOJ settlements show how they be…
Individual Accountability in Corporate Healthcare Cases
DOJ's March 2026 Department-wide Corporate Enforcement Policy keeps individual prosecution the priority in corporate healthcare fr…
Insurance Coverage for FCA Defense Costs
A civil investigative demand can trigger D&O coverage before a lawsuit is filed. What a policy actually pays for, and what it excl…
Healthcare Fraud Takedowns: How Practices Get Swept In
The DOJ's coordinated healthcare fraud takedowns rely on data analytics that flag referring and ordering physicians alongside sche…
Independent Review Organizations: What They Actually Do
Independent review organizations audit claims under a Corporate Integrity Agreement, distinct from health plan appeal reviewers. W…
Individual Liability for Executives Under the FCA
The False Claims Act reaches individual executives, not just companies. What compliance officers need to know about personal expos…
Government Intervention: What the Decision Signals
What DOJ's decision to intervene or decline under 31 U.S.C. § 3730 signals for a qui tam case's value, and why declination does no…
Implied Certification After Escobar
How the Supreme Court's Escobar decision set the two-part implied certification test and a demanding materiality standard courts s…
Healthcare Fraud Sentencing: How Loss Is Calculated
How federal courts calculate actual versus intended loss under Section 2B1.1, and why the billed-amount presumption is often the k…