Tag Archives: government investigations

Does the Medical-School-to-Prison Pipeline Widen in Middle Age?

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The trend of holding physicians personally responsible for healthcare crimes has continued unabated over the past year. As noted in a previous article, physicians are particularly attractive targets for federal prosecutors due to the “special skill” and “abuse of trust” sentencing enhancements found in the U.S. Sentencing Commission Guidelines. While measuring physician participation in illegal activity … Continue Reading

DOJ Takes Aim at Responsible Individuals in Corporate Investigations

By B. Scott McBride and Darby C. Allen on Posted in Uncategorized
U.S. Deputy Attorney General Sally Quillian Yates recently announced new instructions for attorneys at the U.S. Department of Justice (DOJ), outlining in a memorandum the DOJ’s policies with respect to civil and criminal enforcement actions against responsible individuals in corporate investigations. The policy announcement underscores that the federal government is increasingly focused on deterring responsible … Continue Reading

Send Lawyers, Guns and Money:* Providers Lining Up Against Anthem/Cigna and Aetna/Humana Mergers

By Jonathan Lewis on Posted in Uncategorized
In the wake of Anthem’s proposed acquisition of Cigna and Aetna’s proposed acquisition of Humana, providers are lining up to be heard. Take the American Medical Association (AMA), for example, which is urging federal and state regulators to “take a hard look at [the] proposed health insurer mergers” and enforce the antitrust laws that “prohibit … Continue Reading

HHS OIG Creates New Taskforce to Pursue Civil Monetary Penalties and Exclusions

Photo of BakerHostetlerBy BakerHostetler on Posted in Uncategorized
If you have any questions concerning this article, please contact: B. Scott McBride at smcbride@bakerlaw.com or 713.646.1390; Greg Saikin at gsaikin@bakerlaw.com or 713.646.1399 from our Healthcare Investigation and Enforcement team; John J. Carney at jcarney@bakerlaw.com or 212.589.4255; George A. Stamboulidis at gstamboulidis@bakerlaw.com or 212.589.4211 from our White Collar Defense and Corporate Investigations team; or Hilary … Continue Reading

The Deeper Dive: C-Suite to Prison Pipeline

Photo of Robert M. WolinPhoto of Gregory S. SaikinBy Robert M. Wolin and Gregory S. Saikin on Posted in Uncategorized
In recent years, the U.S. Department of Justice (DOJ) has been criticized for failing to prosecute executives for fraud, particularly in the financial sector. In response, the DOJ has begun to more heavily emphasize identifying individual malefactors and prosecuting them. This emphasis is particularly beneficial where a criminal conviction of a healthcare provider entity could … Continue Reading

Justice to Target Corporations and C-Suite Executives in the Healthcare Industry

Photo of BakerHostetlerBy BakerHostetler on Posted in Uncategorized
On Thursday, May 14, 2015, at a meeting of the American Bar Association’s Healthcare Fraud Section, Leslie Caldwell, the Assistant Attorney General for the Department of Justice (DOJ) Criminal Division, declared stamping out healthcare “fraud and holding those who commit this fraud accountable are core missions of the Criminal Division and the Justice Department.” In … Continue Reading

The Medical-School-to-Prison Pipeline Continues to Widen

Photo of Robert M. WolinPhoto of Gregory S. SaikinBy Robert M. Wolin and Gregory S. Saikin on Posted in Uncategorized
Pysicians now appear to be more than ever at a greater risk of investigation for healthcare crimes, largely due to their “gatekeeping” function concerning a patient’s need for medical services and the government’s increased willingness to pursue cases tied to questionable medical necessity. In fact, the recent Medicare fraud indictment of Dr. Solomon E. Melgen … Continue Reading

“Oh Help Me, Please Doctor, I’m Damaged”*—What Does the Future Hold for Hospital-Physician Acquisitions?

By Jonathan Lewis on Posted in Uncategorized
With the ink still drying on the Ninth Circuit’s opinion affirming the Idaho federal district court’s order requiring St. Luke’s Health System to unwind its acquisition of Saltzer Medical Group—a for-profit, physician-owned, multi-specialty group comprising approximately 44 physicians located in Nampa, Idaho—what does the decision mean for other providers? Hospitals considering future acquisitions of physician … Continue Reading

Say Ah! FTC and DOJ to Host Second Workshop on “Examining Health Care Competition

By Jonathan Lewis on Posted in Uncategorized
On February 24-25, 2015, the FTC and the U.S. Department of Justice will host their second workshop on “Examining Health Care Competition.” The workshop will take place in Washington, D.C., and will focus on recent developments related to healthcare provider organization and payment models that may affect competition in the provision of healthcare services. Specific … Continue Reading

Summer Fraud and Abuse Roundup

By Darby C. Allen, Donna S. Clark and B. Scott McBride on Posted in Uncategorized
The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to healthcare fraud and abuse. Group Practice Pays Over $1 Million for Improper Compensation Formula The New York Heart Center, a cardiology … Continue Reading

Government Sues Hospital for Birthing Mama’s Babies

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The Clinica de la Mama case could well serve as an instruction manual of what not to do to stay out of the government’s crosshairs. In this case, several hospitals entered into contracts for Clinica de la Mama to provide “services” including translation, translation management, consulting, eligibility determination, marketing, birth certificate, educational, community outreach and … Continue Reading

Don’t Pop the Cork Just Yet—Growing Criticism of Massachusetts AG’s Settlement with Partners Healthcare Just Might Send the Parties Back to the Drawing Board

By Jonathan Lewis on Posted in Uncategorized
After touting a proposed settlement with Partners HealthCare (Partners) that supposedly would “fundamentally alter [Partners’] negotiating power for 10 years and control health costs across [Partners’] entire network,” Massachusetts Attorney General (AG) Martha Coakley is now playing defense trying to fend off criticism of the deal that just might send the parties back to the drawing board.  … Continue Reading

Buckle Up—Unwinding Phoebe Putney’s Acquisition of Palmyra Down in Georgia May End Up Being Back on the Table

By Jonathan Lewis on Posted in Uncategorized
Almost one year ago, Federal Trade Commission (FTC) agreed to settle its antitrust challenge of Phoebe Putney Health System’s (Phoebe Putney) acquisition of Palmyra Medical Center (Palmyra) without requiring divesture or any other remedial relief. That settlement came after the FTC ran the table in the Supreme Court with a unanimous decision, and convinced a … Continue Reading

Let The Rejoicing Begin, Or Not—Massachusetts AG’s Settlement With Partners Healthcare Is No Harbinger of Things to Come

By Jonathan Lewis on Posted in Uncategorized
After almost half a dozen years of investigating Partners HealthCare’s (Partners) contracting practices and its proposed acquisitions of two competing hospital systems, Massachusetts Attorney General (AG) Martha Coakley announced a “final resolution” that she says “will fundamentally alter [Partners’] negotiating power for 10 years and control health costs across [Partners’] entire network.” But before you … Continue Reading

HHS OCR Settles Post-Data Breach Investigation for Record $4.8M

By Kimberly M. Wong on Posted in Uncategorized
Editor’s Note:  This post originally appeared on BakerHostetler’s Data Privacy Monitor blog. On May 7, 2014, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced a pair of resolution agreements with New York Presbyterian Hospital (NYP) and Columbia University (CU) totaling $4.8 million—the highest data breach settlement amount to … Continue Reading

Do You Know What Your Hospital Board Members Are Doing?

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
David Chandler was appointed to serve as chairman of Tri-Lakes Medical Center (TLMC), a community hospital in Panola County, Mississippi. As chairman, Chandler set board meeting agendas, regularly dealt with the administrator and communicated with department heads to obtain various reports. Chandler also arranged for the hospital’s administrator to meet with a nurse staffing company. … Continue Reading

Pharmaceutical Association Calls Out FTC in Filing Seeking to Enjoin New Rule Targeting the Industry

By Jonathan Lewis and Lee Simowitz on Posted in Uncategorized
Editor’s Note:  This post originally appeared on BakerHostetler’s Antitrust Advocate blog. Last November, the Federal Trade Commission (FTC) with the “concurrence” of the Antitrust Division of the Justice Department, and over the strenuous objection of Pharmaceutical Research and Manufacturers of America (PhRMA), issued final changes to the Hart-Scott-Rodino Act premerger notification rules limited solely to … Continue Reading

FTC Victory in Idaho Hospital-Physician Acquisition Case Should be a Wake-Up Call for Future and Past Deals

By Jonathan Lewis and Lee Simowitz on Posted in Uncategorized
Editor’s Note: This post originally appeared on BakerHostetler’s Antitrust Advocate blog. The ink is still drying on the Idaho federal district court’s order requiring St. Luke’s Health System (“St. Luke’s”) to unwind its acquisition of Saltzer Medical Group (“Saltzer”) – a for-profit, physician-owned, multi-specialty group comprising approximately 44 physicians located in Nampa, Idaho.  But hospitals considering future … Continue Reading
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