The DOJ-OIG Guidelines establish frameworks for detecting and deterring fraud, waste, and abuse in federal healthcare programs. They provide voluntary compliance guidance to help healthcare entities design effective programs that prevent violations of the False Claims Act, Anti-Kickback Statute, and other federal laws. The General Compliance Program Guidance (GCPG) covers seven core elements of an […]
More than 30 states have enacted False Claims Acts, but their strength varies dramatically. California offers the nation’s largest whistleblower reward—up to 50% of total recovery, far exceeding the federal 15-30% range—and covers fraud against private insurers. New York has recovered over $4 billion since 2011 and applies its FCA broadly to “almost any situation
For whistleblowers in healthcare, few topics cause more confusion or concern than HIPAA — the Health Insurance Portability and Accountability Act. While HIPAA protects patient privacy, it also includes specific exceptions that allow whistleblowers to report fraud and abuse lawfully. Under HIPAA, healthcare workers are generally prohibited from disclosing protected health information (PHI). However, 45
Beyond expanding coverage, the Affordable Care Act (ACA) reshaped healthcare fraud enforcement. At Barrett Johnston, we see its fraud provisions as some of the most impactful reforms in modern healthcare law. The ACA strengthened the False Claims Act (FCA) and the Anti-Kickback Statute (AKS), clarifying that any claim tainted by a kickback is automatically a
When the Dodd-Frank Wall Street Reform and Consumer Protection Act became law in 2010, it introduced sweeping financial reforms — and its impact went far beyond Wall Street. At Barrett Johnston, we view Dodd-Frank as a landmark in the evolution of whistleblower protections and incentives across all industries, including healthcare. The Act established the Securities
The Civil Monetary Penalties Law (CMPL) is a critical but sometimes overlooked companion to the False Claims Act. While the FCA focuses on fraud, the CMPL targets a wide range of misconduct that wastes federal healthcare funds. When the conduct at issue concerns federal healthcare programs such as Medicare, the CPML is generally administered by
The Whistleblower Protection Act of 1989 (WPA) marked a defining moment for federal employees who risked their careers to report wrongdoing. At Barrett Johnston, we view it as a foundational piece of modern whistleblower law — one that inspired broader protections across industries, including healthcare. The WPA was designed to protect federal employees who disclose
We often explain that some of the most damaging healthcare fraud doesn’t come from fake bills—it comes from improper relationships between providers and suppliers. The Anti-Kickback Statute (AKS) directly targets this kind of corruption. The AKS is a federal law that prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals
The False Claims Act (FCA) is the single most powerful tool for combating fraud against the U.S. government. It’s also the foundation for nearly every major healthcare fraud case we see today. Originally passed during the Civil War in 1863, the FCA was designed to stop suppliers from defrauding the Union Army. It has since
The Stark Law, formally known as the Physician Self-Referral Law, is one of the most important — and most complex — regulations in healthcare fraud enforcement. At its core, Stark Law prohibits physicians from referring Medicare or Medicaid patients to entities in which they (or an immediate family member) have a financial interest. For example,
