On January 31, 2019, the law firm of Bass, Berry & Sims released its “Healthcare Fraud and Abuse Review 2018.” According to the firm’s press release, “Healthcare providers remain under close scrutiny by regulators amid uncertainty at the highest levels of government, regulatory developments impacting the enforcement environment, and key cases interpreting the False Claims Act (FCA).”
The press release noted, “Federal courts are expected to continue to grapple with the Supreme Court’s opinion in Universal Health Services, Inc. v. U.S. ex rel. Escobar, which already has upended more than $1 billion in jury verdicts involving FCA claims. Litigants are expected to continue to seek review of key appellate decisions involving Escobar and its treatment of the FCA’s materiality requirement.
“Whistleblowers continue to pursue qui tam lawsuits informed by the greater public availability of healthcare provider data.”
The 2018 Healthcare Fraud and Abuse Review press release also noted fraud enforcement developments related to “the opioid crisis, including new prosecutorial task forces aimed at medical professionals who prescribe opioids and companies in the manufacturing and distribution chain. A provision in last fall’s sweeping opioid-related legislation is expected to have a far-reaching impact for clinical laboratories—even labs that do not provide drug treatment, recovery or testing services. Known as the Eliminating Kickbacks in Recovery Act (EKRA) when it was a stand-alone bill, the law establishes all-payor criminal liability for payments tied to referrals, not just for patients covered by government health programs as with the federal Anti-Kickback Statute.”
According to the press release, pharmaceutical manufacturers should “pay close attention to the activities of and relationships with any patient assistance programs and charitable foundations that help patients.” In 2018 there were numerous settlements “involving multi-million dollar payments and corporate integrity agreements.”
For the “Healthcare Fraud and Abuse Review 2018”: https://fraudinhealthcare.com/