Tag Archives: healthcare fraud

Healthcare Fraud Takedowns

As a former federal prosecutor in Chicago, I am well acquainted with the phrase “takedowns.”  For the unwary, a subject-area “takedown” is a practice used by federal prosecutors to send a message to a given industry.  Prosecutors investigate and prepare to charge cases in a given industry sector and then release the charges nationally on the same day along with a press release.  The idea is that such public “takedowns” serve as a deterrent to future criminal activity in the industry. For example, almost every April 15th, prosecutors across the country release charges in dozens of tax-fraud cases. Continue reading Healthcare Fraud Takedowns

Supreme Court’s Materiality Standard in United Health Services, Inc. v. U.S. ex rel. Escobar May Limit Criminal Liability in Healthcare Fraud Prosecutions

By Amanda L. Bassen and Michael E. Clark

In healthcare fraud prosecutions under the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)), the knowing or willful solicitation or receipt, either directly or indirectly, of any remuneration (including kickbacks, bribes or rebates) in exchange for the referral of patients for items or services covered by a federal healthcare program is a criminal offense.  In the seminal case of United States v. Greber, 760 F.2d 68 (3d Cir. 1985), the Third Circuit articulated the “one purpose test,” where so long as “one purpose” of a payment is to induce a referral, a criminal conviction may be sustained under the Anti-Kickback Statute, even if there are other, legitimate purposes for the payment.  Greber’s “one purpose test” has been widely adopted in Anti-Kickback prosecutions.   Continue reading Supreme Court’s Materiality Standard in United Health Services, Inc. v. U.S. ex rel. Escobar May Limit Criminal Liability in Healthcare Fraud Prosecutions