This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for June 2023. We discuss
several civil enforcement actions involving false claims, the Anti-Kickback Statute (AKS) and patient health information
allegations. We also discuss notable developments around Transitional Coverage for Emerging Technologies (TCET) and other
healthcare regulatory updates.
NOTABLE CIVIL ENFORCEMENT
RESOLUTIONS AND ACTIVITY
CALIFORNIA PROVIDERS SETTLE “ENHANCED SERVICES” FALSE CLAIMS ALLEGATIONS
FOR $68 MILLION
Three California providers agreed to pay a combined $68 million to resolve allegations that they violated the federal False Claims
Act (FCA) and the California False Claims Act by submitting or causing the submission of false claims related to the Patient
Protection and Affordable Care Act’s (ACA’s) Medicaid Adult Expansion. The providers had entered into a contract with the
California Department of Health Care Services, which contract included a provision stating that if the providers did not spend at
least 85% of the funds they received for the Medicaid Adult Expansion population on “allowed medical expenses,” they would be
required to pay back to California the difference between 85% and the percentage of the received funds they actually spent—and in
turn, California would need to requisition such amount to the federal government. The US Department of Justice (DOJ) alleged that
the providers submitted false claims for “enhanced services” in...
Dr. Natalia Krasovkaya, director of the National Center for Public Diplomacy (CND), has recently circulated in online publications accusing her of involvement in recruiting African nationals for t...