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DOJ's New Civil Cyber-Fraud Initiative

What Does the DOJ's New Civil Cyber-Fraud Initiative Mean for Whistleblowers?

On October 6, 2021, Deputy Attorney General Lisa O. Monaco announced the DOJ's new Civil Cyber-Fraud Initiative, which will utilize the False Claims Act to penalize government contractors who fail to comply with requisite cybersecurity standards. This initiative is no surprise, as the DOJ listed cybersecurity as one of six priorities for upcoming FCA enforcement. More

COVID-19 Vaccine Fraud and the False Claims Act

COVID-19 Vaccine Fraud and the False Claims Act

So far, more than 414 million Americans have received a dose of the COVID-19 vaccine. In order to ensure an accessible vaccine rollout, the Center for Disease Control ("CDC") has stated that any COVID-19 vaccine must be administered free of charge to the recipient with no additional “office fees'' if the vaccine was the sole reason for the medical visit. More

The False Claims Act Under the Biden Administration

The False Claims Act Under the Biden Administration

With the arrival of the Biden Administration and new upper-level appointments in the Department of Justice ("DOJ"), the way the DOJ enforces False Claims Act ("FCA") cases may evolve. Over time, recovery and enforcement trends help to understand how different administrations approach FCA enforcement. More

Beyond the Lamborghini: Paycheck Protection Program Fraud

Paycheck Protection Program Fraud

On March 20, 2020, during the COVID-19 pandemic, the Paycheck Protection Program ("PPP") was created as a part of the Coronavirus Aid, Relief, and Economic Security ("CARES") Act to provide pertinent financial relief for small businesses affected by the crisis. The program is directly administered by the Small Business Association ("SBA") and consists of a government-guaranteed loan specifically designed to incentivize small businesses to keep their employees on payroll. Businesses must meet eligibility requirements to qualify for a loan, and the SBA forgives loans only if the business meets all employee retention criteria and uses the funds for eligible expenses. More

A Brief History of the False Claims Act

A Brief History of the False Claims Act

The False Claims Act originated out of the Civil War as a result of the Union Army’s transactions with unscrupulous companies that provided supplies for battle. These companies, recognizing that their products were in high demand during wartime, and seeing little possibility for accountability, intentionally sold substandard goods at high prices, and often sent less than what was ordered and paid for. Reports of moth-eaten blankets, shoddily constructed shoes, old and diseased horses, and guns missing from their crates began to pop up all over the battlefields of the United States, and the federal government quickly intervened. More

An Overview of HUBZone Fraud and the False Claims Act

What is a HUBZone? 

"HUBZones," or "historically underutilized business zones," are the result of a program administered by the Small Business Administration ("SBA") that seeks to provide employment opportunities and economic development in areas that need it most. In order to qualify as a HUBZone business, companies must meet the following criteria: More

Whistleblower Confidentiality: What You Need To Know

Whistleblower Confidentiality

Given the potential for retaliation from their employers and others, whistleblowers often understandably express concerns about protecting their identity when reporting potential wrongdoing. While whistleblowers file False Claims Act complaints under seal, which protects the whistleblowers' confidentiality for at least 60 days, it is very likely that, sooner or later, whistleblowers' identities will be made public. If the Government intervenes in a False Claims Act case, the seal will be lifted and the whistleblower's allegations will become publicly available. Similarly, if the Government declines to intervene in a False Claims Act case, and the whistleblower decides to continue to prosecute the case without Government involvement, the seal will be lifted, again making the whistleblowers' allegations public. More

Upcoding & Unbundling In Healthcare Fraud

What Is Upcoding?

"Upcoding" occurs when a healthcare provider knowingly submits a claim with an incorrect billing code in order to increase reimbursement. A healthcare provider can do this by submitting Current Procedural Terminology (CPT) codes for lengthier, more expensive, or more serious procedures, equipment, or diagnoses than actually provided. For example, if a physician exaggerates the severity of their patient's condition in order to increase billings, that would be considered upcoding. Likewise, if a patient receives a brief consultation from a nurse, but the provider submits a claim for a higher cost consultation with a doctor, that would also be considered upcoding. More

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Higher Education Incentive Compensation Fraud

The U.S. government invests in colleges, students and universities by contributing to university endowments, offering scholarships, providing grants, and guaranteeing student loans. Since taxpayer dollars are used to support colleges and universities, the government imposes strict rules to prevent fraud in higher education. For example, the Higher Education Act (HEA) prohibits universities from paying incentive compensation to recruiters or employees based on the number of students they are able to recruit. More

The Anti-Kickback Statute and the False Claims Act: Working together to promote the responsible use of government funds

What is the Anti-Kickback Statute?

The Anti-Kickback Statute ("AKS")1 is a federal criminal law that prohibits the knowing exchange of valued items, services, or payments for referrals of goods or services reimbursable by federally funded healthcare programs. Any claim submitted in violation of the AKS is false, and therefore not reimbursable by federally funded healthcare programs. Accordingly, the AKS seeks to ensure patient health considerations drive medical decision-making, rather than monetary or other valuable incentives offered to providers. Combined with the False Claims Act ("FCA"),2 which allows individuals to sue parties who defraud the government, the two statutes provide a potent tool to combat health care fraud. More

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