Tag:DOJ
The Sicker, The Better: Cigna Orchestrates Fraudulent Scheme to Defraud Government
Cigna Corporation (Cigna)–a global juggernaut in the insurance arena–faces a health care fraud lawsuit brought by the government under the federal False Claims Act (the FCA). By allegedly exaggerating patients’ illnesses to boost its own risk scores, Cigna secured inflated payments from the Medicare Advantage reimbursement system.
Big Tech & Its Algorithms: Is It Time to Hold Them Accountable?
It’s no secret that companies like Google, Alpha, Meta, and Twitter use and sell our data. However, in recent years, the content that companies display to us while we use their platform, from the ads we see to the websites that we find on search engines, has become a major contentious issue. While Section 230 of the 1996 Communications Decency Act shields Big Tech and other online platforms from liability for user-generated content, the Supreme Court recently announced that it will hear Gonzalez v. Google. The outcome of this case could have a huge impact on tech policy and could fundamentally change the type of content that we see online.
DOJ’s Unveils New Tool to Fight Corporate Crime: Care About Compliance
In an effort to deter corporate crime, the Justice Department (DOJ) has implemented a new policy aimed at giving chief compliance officers more authority. Chief Compliance Officers (CCOs) may now need to certify the integrity of their compliance programs and be personally liable if their programs do not “reasonably prevent and deter compliance issues.” According to Brian Michael, a former chief compliance officer (CCO), some industry professionals fear that such a policy would place compliance officers in a position to be personally liable for decisions that they have little say over. There is also worry that implementing such a policy would place CCOs in direct conflict with senior executives. However, Kenneth Polite, assistant attorney general in charge of the DOJ’s criminal division, insists that the new policy will place CCOs in a better position to ensure the integrity of their compliance programs. Polite hopes to force corporations to invest in compliance now rather than pay later.
Possible Pitfalls of the New DOJ Compliance Policy
In March 2022, the U.S. Department of Justice (DOJ) introduced a new policy idea that requires a Chief Compliance Officer (CCO) undergo certification. This certification requires CCOs to attest at the end of company resolutions that their compliance program is reasonably designed to detect and promptly remedy behavior suspected or known to be in violation of applicable laws. The new policy is part of an effort to take more proactive measures against criminal behavior and activities such as fraud, bribery, corruption, etc. The certification is also aimed at empowering the CCOs as they speak on behalf of their company’s obligations to the compliance program.
DOJ Renews Efforts to Prosecute White-Collar Crime
In October of 2021, the Department of Justice (“DOJ”) announced it would ramp up its enforcement against corporate repeat offenders of white-collar crimes and prioritize action against individual actors to promote accountability. The new measures implemented permit the DOJ to consider all prior wrongdoing by a corporation when deciding how to resolve a new investigation. Leniency programs of the past will not be extended to wrongdoers unless all believed participants, whether employees or executives, are disclosed. There has also been a shift from financial penalties to probationary settlements, which require companies not only to admit fault and pay fines but also to improve their monitoring of employees to deter crime. This may require outside monitoring to verify compliance, which can be burdensome and expensive.
Congress Should Revisit the Federal Vacancies Reform Act
In 1998, Congress passed legislation to address vacancies created when a high-ranking official of an executive branch agency leaves their position. The Federal Vacancies Reform Act (FVRA) establishes a time limit of 210 days from the date of a vacancy for which a person may serve in an acting capacity in a position that is otherwise nominated by the President, with advice and consent of the Senate. The FVRA allows acting officials to serve beyond that time if there is a first or second nomination pending in the Senate for the vacancy. However, certain agencies have supplemental succession plans within their enabling statues that may supersede or complicate the FVRA.
The DOJ Challenges Penguin Random House’s Acquisition of Simon & Schuster
In the United States, “The Big Five” denote the largest five publishing houses. These publishing empires print everything from medical textbooks to children’s books and together control over eighty percent of the publishing market. The Big Five includes Penguin Random House, HarperCollins, Simon & Schuster, Hachette, and Macmillan. In November of 2020, Viacom announced the sale of Simon & Schuster to Penguin Random House for $2.175 billion. A year later on November 2, 2021, the U.S. Department of Justice announced a lawsuit challenging the acquisition to ensure “fair competition in the U.S. publishing industry.”
The DOJ Launches a National Nursing Home Initiative
On March 3, 2020, the Department of Justice (“DOJ”) launched a National Nursing Home Initiative to “coordinate and enhance civil and criminal efforts to pursue nursing homes and long-term care facilities that provide grossly substandard care to their residents.” The DOJ’s new initiative adds to its extensive efforts to combat elder abuse and financial fraud targeted at American seniors. The initiative will start with a focus on some of the worst nursing homes and enhance all civil and criminal efforts to pursue the nursing homes that provide grossly substandard care to their residents.
Escobar’s Materiality Standard Shields Organizations from the Risk in Risk Adjustment Payments
Finance Director for UnitedHealth Group brought qui tam suit against UnitedHealth Group, Inc. alleging that the organization upcoded risk adjustment data resulting in increased payments (more than $1.14 billion) to UnitedHealth Group. The Department of Justice (DOJ) intervened in the case, yet UnitedHealth Group was successful in getting the primary False Claims Act Claims dismissed by arguing that the Centers for Medicare & Medicaid Services (CMS) would not have refused to make the adjustment payments had they known of the errors in the risk adjustment. The Escobar materiality standard helps clarify threshold level of risk to Managed Care Providers in attesting to their risk adjustment payments; the falsities must have had an impact on the respective payment.
My Summer with the Office of Inspector General for the U.S. Department of Health and Human Services
This summer I had the opportunity to intern with the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) in Washington, DC. I thoroughly enjoyed my time with OIG, and I learned a great deal about health care fraud, waste, and abuse. In spending my summer with OIG, I had a glimpse into the powerful regulatory bodies that protect the health care market from abuse. As I move forward with my career in regulatory work, I will take with me the invaluable experiences and skills from my internship.