Fraud and False Claims

Given the complexity and changing rules and regulations within the health care industry, it is no surprise health care remains a focal point of False Claim Act (“FCA”), Stark and Anti-Kickback enforcement. The government continues its efforts to combat fraud, abuse, and waste in the healthcare arena. The steadily rising number of FCA investigations and qui tam actions evidences this. Claro professionals assist companies and their counsel when faced with quantifying, analyzing and replying to allegations. Claro successfully strategizes with clients and their counsel to simplifying complex data/topics into logical elements that can be explained in clear analyses.

Claro has experience dealing with a range of issues in healthcare fraud and FCA matters, including:

  • Noncompliance of contacts
  • Medicare and Medicaid reimbursement fraud
  • Quantification of Company’s crime policy
  • Fraudulent representation of healthcare transactions revenue
  • Pharmacy network exclusion and billing fraud
  • Economic damages analysis relating to collusion