Compliance & Ethics

Healthcare providers across the U.S. have just learned a hard lesson about accountability, with two high-profile cases settling for a combined $25.9 million. The Department of Justice’s latest actions spotlight fraudulent billing practices that took advantage of Medicare, the government program designed to help the nation’s elderly and vulnerable. In one case, a pharmacy found itself caught up in the scam of submitting false claims for COVID-19 tests it never shipped. In the other, a network of cardiology practices saw a significant financial hit after overbilling Medicare for diagnostic drugs, some for over a decade.

It was billed as the future of finance: a stablecoin so steady it could weather any storm. Yet, when Terra USD (UST) lost its $1 peg in May 2021, the cracks in that promise were glaringly exposed. Now, Tai Mo Shan Limited, a key player in propping up UST’s illusory stability, is facing a $123 million reckoning from the Securities and Exchange Commission (SEC).

Independent Health Association, along with its affiliate Independent Health Corporation, has agreed to pay up to $98 million to settle allegations of defrauding Medicare. The Buffalo-based Medicare Advantage provider is accused of inflating risk scores—a critical metric in determining payments under the Medicare Advantage (MA) program.

Deutsche Bank Securities Inc., the broker-dealer arm of Deutsche Bank AG, is paying a hefty $4 million civil penalty after the U.S. Securities and Exchange Commission (SEC) found that it repeatedly missed the deadline to file Suspicious Activity Reports (SARs). These reports are crucial tools in the fight against financial crime, and Deutsche Bank’s delay in filing them hindered important investigations into possible illicit activities.

Wells Fargo Clearing Services and LPL Financial have agreed to pay $900,000 each to settle charges with the U.S. Securities and Exchange Commission (SEC). The charges stem from the firms' failure to provide complete and accurate securities trading data, known as blue sheet data, to the SEC, a key component of the agency’s market surveillance.

The Consumer Financial Protection Bureau (CFPB) is making waves with a bold lawsuit against some of the country’s biggest banks—Bank of America, JPMorgan Chase, and Wells Fargo—as well as Early Warning Services, the company behind Zelle. The lawsuit alleges these institutions have turned a blind eye to rampant fraud on the popular peer-to-peer payment platform, which, according to the CFPB, has led to over $870 million in consumer losses since Zelle’s launch in 2017.

In a global health supply chain snafu, Chemonics International Inc. has agreed to fork over $3.1 million to settle allegations it submitted fraudulent claims to the U.S. Agency for International Development (USAID). The international development firm, based in Washington, D.C., found itself in hot water after charges of reckless oversight regarding its subcontractor’s billing practices surfaced.