Healthcare Valuation Blog

The Department of Justice (DOJ) news page features several noteworthy settlements related to individual physicians involved in alleged medical laboratory kickback schemes. Enforcement action is likely to continue in the medical lab industry, which is upward of $250.9 billion in size and still growing.[1] Physicians who are key to this growth may not realize the extent of their exposure to prosecution in arrangements that seem like win-wins. However, common threads throughout

Recently, DOJ announced that pharmaceutical giant Pfizer, on behalf of its subsidiary, Biohaven Pharmaceutical Holding Company Ltd. (“Biohaven”), has agreed to pay nearly $60 million to resolve allegations that Biohaven knowingly caused the submission of false claims to Medicare and other federal health care programs by paying kickbacks to health care providers (“HCPs”) to induce prescriptions of Biohaven’s migraine drug Nurtec ODT before Pfizer acquired the company. The sett

Major events of 2024 delivered heavy helpings of dispute, debate, and contention. Alongside the clashes in politics and culture,...

In September 2024, the Department of Justice (“DOJ”) announced that Siouxland Surgery Center LLP, doing business as Dunes Surgical...

In February 2024, the U.S. Department of Justice (“DOJ”) joined a second whistleblower complaint against a former executive at Illinois-based Cardiac Imaging Inc. (“CII”), a mobile imaging company providing diagnostic cardiac positron emission tomography (“PET”) services. The allegations echo those addressed by the $85 million settlement reached in October 2023, which resolved alleged False Claims Act violations caused by excessive payments made to referring cardiologists by

In December 2023, an Indianapolis-based health system agreed to pay $345 million to settle allegations of False Claims Act and Stark Law...

In November 2023, Prema Thekkek, her management company, Paksn Inc. (“Paksn”), and 6 SNFs that are owned by Thekkek or managed by Paksn...

Four home healthcare settlements related to improper payments to physicians have been announced by the Department of Justice (“DOJ”). ...

In August 2023, the Department of Justice (“DOJ”) announced that Watermark Retirement Communities, LLC (“Watermark”), based in Tucson,...

In April 2023, the Department of Justice (“DOJ”) announced that Sibley Memorial Hospital (“SMH”) and its parent company, Johns Hopkins...

The American Bar Association’s 33rd Annual National Institute on Health Care Fraud was held in Chicago on May 4, 2023. Deputy Assistant...

A $69 million settlement related to improper financial relationships between physicians and a large health system was announced on March...

In December 2022, a Sarasota, Florida, pain management physician was sentenced to three years and six months in federal prison and ordered to forfeit $278,900 in kickbacks and bribes. According to evidence presented at trial, in less than three years, the physician’s prescriptions for Subsys, a fentanyl sublingual spray used to relieve breakthrough pain in cancer patients, had amounted to over $4.5 million in Medicare Part D payments to Insys Therapeutics, Inc., the drug’s ma

On July 7, 2022, The Department of Justice ("DOJ") announced that Weirton Medical Center (WMC), a 167-bed hospital located in Weirton,...

Earlier this year, radiation therapy provider SightLine Health reached a $11.5m settlement with the DOJ in a lawsuit alleging it knowingly violated the federal physician self-referral and anti-kickback laws. Financial Arrangement According to the complaint, SightLine’s operating model was to build a radiation therapy center in a new market, and “syndicate” ownership of the center among referring physicians (primarily urologists). Sightline would keep 20% ownership of the JV