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Health care providers: Fraud developments to watch in 2019

Health care fraud disputes were present throughout 2018. These cases included everything from individual physicians, nurses and other health care professionals fighting boards for their professional licenses to multi-million dollar Anti-Kickback Statute (AKS) violations cases — as discussed in a previous post, available here.

Two additional issues that will likely play a large role in health care fraud cases in 2019 include:


  • False Claims Act (FCA) cases. The Supreme Court of the United States (SCOTUS) took on the materiality requirement in FCA cases. Federal courts throughout the country will continue to grapple with this decision. Qui tam lawsuits are also projected to continue to grow in regularity throughout 2019. This is due to the increased availability of health care data. Health care providers are wise to implement tools to review this data to better ensure they are in compliance with applicable regulations.
  • Opioid enforcement. The Department of Justice (DOJ) provided enforcement guidance in 2018 to help curb the growing opioid epidemic. As such, physicians and other medical providers will likely find their use of opioid medication prescriptions under increased scrutiny. Businesses that operate in the manufacturing and distribution of opioid containing medications will also face increased scrutiny.

Physicians, medical professionals or businesses that find themselves the subject of a government investigation for healthcare fraud are wise to act to protect their interests. An attorney experienced in the laws and regulations in this field can help to protect your interests and reputation during the investigation and build a defense to any resulting allegations.

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