Healthcare Fraud Involving Home Sleep Studies: What Do California Doctors and Service Providers Need to Know?
A recent trend in healthcare fraud enforcement involves private insurers and the federal government targeting doctors who recommend patients for home sleep studies (HSS) and HSS service providers. Currently, the insurance companies and federal agencies including the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human...
Read moreContinuous Glucose Monitoring (CGM) Medicare Compliance
In 2018, the Centers for Medicare and Medicaid Services (CMS) expanded Medicare coverage for continuous glucose monitoring (CGM). While this is good news for program beneficiaries who need CGM, billing compliance has proven to be a challenge for many pharmacies and other healthcare providers. When continuous glucose monitoring (CGM) was...
Read moreWhy Should You Try to Prove “No Intent” in a False Claims Act Investigation or Other Federal Criminal Case?
In federal cases involving allegations of healthcare fraud and various other white-collar offenses, the difference between facing criminal charges and civil charges (or no charges at all) is often the element of criminal "intent." If you are being targeted under a statute such as the False Claims Act that includes...
Read moreCriminal ERISA Investigations Targeting Multiemployer Retirement Plans (MEPs)
As explained by the Pension Benefit Guaranty Corporation (PBGC), “[a] multiemployer plan is a collectively bargained plan maintained by more than one employer, usually within the same or related industries, and a labor union. These plans are often referred to as ‘Taft-Hartley plans.’” Multiemployer plans can often be cost-effective options...
Read moreWhat Does the Federal Government Have to Prove in Order to Establish Criminal “Intent”?
In many cases, the federal government has the option to either pursue civil or criminal charges against an individual suspected of violating the law. In deciding whether to pursue civil or criminal charges, the key distinguishing factor is often the element of criminal “intent.” While many federal laws allow for...
Read moreCriminal ERISA Enforcement Involving Pensions and 401(k) Plans
Employer-sponsored retirement plans are subject to the requirements of the Employee Retirement Income Security Act of 1974 (more-commonly known by its acronym, “ERISA”). While ERISA violations involving pensions and 401(k) plans have the potential to lead to civil litigation – including potential class action litigation – an even greater risk...
Read more6 Ways to Protect Yourself After Receiving a Federal Grand Jury Subpoena
Upon being served with a federal grand jury subpoena, the process of protecting yourself begins immediately. Whether you are being targeted in the government’s investigation or you are currently being treated as a witness (or, as is often the case, you have no idea), the risks of inaction are substantial,...
Read moreFraud Under ERISA: Fighting Criminal Charges Against Business Owners, Plan Managers, Trustees, and Other Individuals
The Employee Retirement Income Security Act of 1974 (more-commonly known by its acronym, “ERISA”) is a federal statute that imposes affirmative obligations and other requirements in relation to the management of employer-sponsored retirement and benefit plans. ERISA exists in order to protect plan participants’ retirement savings and other accumulated benefits,...
Read moreHow Can You Convince the Federal Government that You Did Not Have Criminal “Intent”?
Whether you are currently the subject of a federal investigation or you have been indicted on federal criminal charges, a key component of your defense strategy is likely to focus on challenging the government’s evidence of criminal “intent.” If you are under investigation, you want to keep the investigation civil...
Read more10 Types of Information Sought in Federal Grand Jury Subpoenas
The U.S. Attorney's Office has broad authority to compel testimony and the production of records through the issuance of federal grand jury subpoenas. Federal grand jury subpoenas ad testifacandum (requiring testimony) and federal grand jury subpoenas duces tecum (requiring document production) can be extraordinarily broad, and they generally are not...
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