Articles Tagged: Healthcare Fraud

 

DOJ’s New National Fraud Detection Center Signals Broader, Faster Fraud Enforcement

The Justice Department has announced a new National Fraud Detection Center, a prosecutor-led, multi-agency effort designed to generate criminal leads involving fraud against taxpayer-funded programs. Although this is not a court decision, it is a significant enforcement development with immediate implications for companies and individuals operating in heavily regulated sectors, especially healthcare, government procurement, and public benefits.

The new center appears aimed at centralizing fraud detection and accelerating the path from data analysis to investigation.

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DOJ Unseals “War Room” Indictment Alleging RICO Enterprise and $12 Million Medicaid Fraud

Federal prosecutors have unsealed a nine-count indictment charging Louis Trejo, Kenneth Garner, Harold Stevenson, and Erihk Belis in a sweeping alleged scheme that combines classic healthcare fraud allegations with racketeering, firearms, narcotics, money laundering, and violence-related counts. According to the Justice Department, the case centers on an alleged “War Room” enterprise that used fabricated transportation data to support at least $12 million in fraudulent Medicaid claims.

The charging mix is what makes this filing especially notable.

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Veloxis to Pay $46 Million in Envarsus XR Kickback Resolution

Veloxis Pharmaceuticals has agreed to pay more than $46 million to resolve criminal and civil allegations that it used kickbacks to drive prescriptions and purchases of Envarsus XR, its kidney-transplant drug. According to the Department of Justice, the resolution includes a deferred prosecution agreement tied to a criminal information filed in the U.S. District Court for the District of Massachusetts, underscoring the government’s continued focus on pharmaceutical marketing practices that allegedly influence prescribing decisions.

The matter is significant because it combines both criminal and civil exposure in a single healthcare-fraud resolution.

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Nevada Indictment Targets Alleged $95 Million Medicare Wound-Graft Fraud

The Department of Justice has announced a major healthcare-fraud prosecution in Nevada, where a federal grand jury indicted physician Stephen Dubin, M.D., in connection with an alleged $95 million Medicare fraud scheme involving amniotic wound allografts. According to the government, the case centers on claims that medically unnecessary grafts were billed for elderly patients, making it one of the more significant recent criminal matters tied to Medicare reimbursement and wound-care products.

The allegations are notable both for their scale and for the product category involved.

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DOJ’s Late-Summer Enforcement Tempo Signals Broad Federal Risk Across Sectors

The Department of Justice’s recent press-release activity points to a notable trend for legal professionals: federal enforcement remains active on multiple fronts at once. In late July and early August, DOJ announcements reflected a steady mix of healthcare-fraud resolutions, terrorism-related charges, and other criminal prosecutions, underscoring that the government is continuing to deploy both its criminal and civil tools aggressively across industries and fact patterns.

That matters because the news is not just about any single headline-making case.

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DOJ’s $36.4 Million Access DX Settlement Puts Genetic-Testing FCA Risk Back in Focus

The Justice Department has announced a $36.4 million settlement with Access DX Laboratory, its former CEO Michael Stewart, and Florida businessman Harold Shatz to resolve allegations that the defendants participated in a kickback-driven scheme involving medically unnecessary genetic testing billed to Medicare and Medicaid. The case is the latest sign that federal healthcare-fraud enforcement remains sharply focused on laboratory testing arrangements, referral relationships, and claims tied to questionable medical necessity.

According to the government, the settlement resolves allegations under the False Claims Act arising from payments intended to generate referrals for expensive genetic tests, along with the submission of claims to federal healthcare programs for tests that were not medically necessary.

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Fifth Circuit Upholds Boston Heart Kickback Convictions in Anti-Kickback Scheme

The Fifth Circuit has affirmed the convictions of former Boston Heart Diagnostics executives and sales representatives in a criminal Anti-Kickback Statute case arising from what prosecutors described as a sham management-services organization structure used to funnel payments to physicians in exchange for referrals. The decision in United States v. Theiler leaves intact conspiracy convictions tied to a broader healthcare-billing and referral scheme involving Boston Heart Diagnostics, Inc. and several individual defendants, including Susan Hertzberg, Matthew Theiler, David Kraus, and Thomas Hardaway.

For healthcare enforcement practitioners, the ruling is a notable appellate endorsement of the government’s theory that formally documented business arrangements can still amount to criminal kickback conduct when the substance of the arrangement is referral-driven.

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Texas COVID-Testing Fraud Case Ends in $24 Million DOJ Settlement

Federal authorities have announced a $24 million civil fraud settlement involving a Dallas laboratory and certain owners and investors over alleged misconduct tied to COVID-19 testing. The resolution is a notable reminder that pandemic-era billing practices remain a live enforcement priority, especially where the government believes testing claims were inflated, medically unnecessary, or otherwise noncompliant.

Although the matter was resolved through settlement rather than a litigated judgment, the size of the payment underscores how aggressively the Department of Justice continues to use civil fraud tools in the healthcare space.

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DOJ’s $6.5 Billion Healthcare Fraud Takedown Signals Aggressive Enforcement Across Federal Districts

The Justice Department has announced one of its largest coordinated healthcare fraud enforcement actions to date, charging 455 defendants in connection with more than $6.5 billion in alleged false claims.

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DOJ’s $8.33M Modern Nuclear Settlement Puts Kickback Risk in Mobile Imaging Back in Focus

The Justice Department has announced an $8.33 million settlement with Modern Nuclear to resolve allegations that the company paid unlawful kickbacks to medical practices tied to its mobile PET scan services, leading to claims reimbursed by federal healthcare programs. While the matter was resolved without a determination of liability, the settlement is a notable reminder that the government continues to treat kickback-driven referral arrangements as a core healthcare-fraud enforcement priority.

According to the government’s allegations, the company’s financial arrangements with physician practices crossed the line from legitimate business relationships into conduct that potentially violated the Anti-Kickback Statute. That matters because claims submitted to federal programs that are allegedly tainted by kickbacks can also trigger liability under the False Claims Act, dramatically increasing exposure through treble damages and per-claim penalties.

For legal and compliance professionals, the case underscores a recurring enforcement theory: even when the underlying services are medically appropriate, the manner in which referrals are obtained can create FCA risk.

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