2024 U.S. Health Care Fraud, Waste & Abuse Trends (Part III): Enforcement Actions

This podcast, the third in a series, features Michael Lampert and Andrew O'Connor from Ropes & Gray discussing recent enforcement trends related to fraud, waste, and abuse, particularly DOJ settlements. The discussion covers the expansion of False Claims Act cases beyond traditional providers to vendors and technology providers, with examples like BioTelemetry and NextGen Healthcare. They delve into Medicare Advantage risk scoring practices, highlighting settlements with Cigna and Martin's Point, emphasizing the importance of accurate diagnosis reporting and compliance infrastructure. The podcast further explores Stark Law settlements, clinical lab cases involving free testing and commission structures, and DOJ's encouragement of self-disclosure, including the new whistleblower program and M&A safe harbor policy. Finally, they analyze recent Supreme Court decisions impacting the False Claims Act, including the SuperValue and Polanski cases, and discuss the potential implications of the Hansen case on the anti-kickback statute.