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American hospitals have been resistant to whistleblowers. Here’s how they can save money and lives by embracing them.

Posted 06/21/22

Last month, the American Hospital Association wrote a pointed letter to the Justice Department, asking them to investigate, and potentially sue, Medicare Advantage plans for improperly denying coverage of patients’ hospital services. Medicare Advantage is a popular government program that pays private insurers premiums to cover seniors, and the insurers are required by law to provide at least the same benefits as...

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers,

As Whistleblowers and Quality Care Advocates, Hospitalists are the Conscience of Healthcare

Posted 02/28/22

Thursday, March 3, 2022 is National Hospitalist Day, a day we recognize the contributions of the specialist care doctors and other professionals who provide quality care to sick and vulnerable patients in a hospital. As the fastest growing specialty in modern medicine, hospitalists are a critical part of the nation’s health care service delivery system. Less noted but no less important, hospitalists also play a...

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers, Upcoding,

Top 5 Reasons Why Nurses Make Great Whistleblowers

Posted 02/22/22

Nurses are rightly getting a lot of attention lately for the courageous and essential role they are playing on the front-line during the COVID-19 pandemic. Whether in hospitals, nursing homes, hospices, or as home health workers, nurses are finally “learning what they are worth,” even as private equity firms seek to profit from nurses’ increased wage-earning power. As reported by STAT, Congress is now...

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers, Whistleblower Eligibility,

Catch of the Week: University of Miami to Pay $22 Million to Resolve Allegations of Lab Test Fraud

Posted 05/14/21

The University of Miami will pay $22 million to resolve three False Claims Act lawsuits, the first of which was filed in 2013. The government alleged that UM, which operates a medical school out of Jackson Memorial Hospital and an extensive health system spanning four south Florida counties, fraudulently billed government health care programs to boost declining revenues. Jackson Memorial will separately pay $1.1...

Tagged in: Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders, Write Mary Inman and Max Voldman in RACMonitor

Posted 06/10/20

attorney headshots of Mary Inman and Max Voldman

Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman updated their earlier reporting in RAC Monitor regarding the False Claims Act case brought by Integra Med Analytics against Texas-based hospital chain Baylor Scott & White. At the end of May, the Fifth Circuit Court of Appeals upheld a Texas district court opinion dismissing the case. As we have earlier written, Integra alleged that the...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Public Disclosure and Public Information, Upcoding, Whistleblower Eligibility,

Financial Pressures on U.S. Hospitals, Combined with New Funding, Increase Risk of Medicare and Medicaid Fraud

Posted 05/22/20

Multistory hospital building set amid trees

Hospitals are an institution we might have expected to be prepared for a healthcare crisis. It is their job, after all, to provide emergency and intensive healthcare. In fact, however, the COVID-19 crisis has put enormous pressures on hospitals. With such new pressures come new risks of healthcare fraud at hospitals.

The Financial Pressures on Hospitals in the COVID-19 Crisis

Against the backdrop of heroic...

Tagged in: COVID-19, FCA Federal, Government Programs Fraud, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers,

Top Ten Healthcare Fraud Recoveries of 2019

Posted 01/24/20

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Is Data the Future of Whistleblowing?

Posted 08/28/19

Two recent decisions, one in California and the other in Texas, might be signaling a new frontier in False Claims Act (FCA) litigation: the data-driven whistleblower. Both cases are brought by the same whistleblower, Integra. Integra is not a typical whistleblower, which are generally corporate insiders or other employees of a company that is accused of defrauding the government. Instead, Integra is a corporation that...

Tagged in: FCA Federal, FCA State, Hospital Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, Public Disclosure and Public Information, Whistleblower Case, Whistleblower Eligibility,

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Posted 05/24/19

Earlier this month, a Utah-based hospital chain announced it would settle whistleblower Dr. Gerald Polukoff’s case alleging the hospital performed unnecessary heart surgeries on Medicare patients, thereby overcharging the federal government in violation of the False Claims Act (FCA). Defendant Intermountain Health, the largest healthcare provider in the Intermountain West, had petitioned the U.S. Supreme Court to...

Tagged in: Court Decision, FCA Federal, FCA Pleading, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity,

Catch of the Week — Florida Hospital Chain CEO Settles False Billing Allegations

Posted 05/3/19

Emergency Room Hospital with Night Lights On

This week’s Catch of the Week highlights former hospital executive Gary D. Newsome’s settlement resolving false billing and kickback allegations. From 2008 to 2013, Newsome served as CEO of Naples, Florida-based hospital chain Health Management Associates, LLC (HMA). He will pay $3.46 million to resolve federal prosecutors’ claims that HMA, under his leadership, pressured doctors in the emergency department to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud,

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American hospitals have been resistant to whistleblowers. Here’s how they can save money and lives by embracing them.

As Whistleblowers and Quality Care Advocates, Hospitalists are the Conscience of Healthcare

Top 5 Reasons Why Nurses Make Great Whistleblowers

Catch of the Week: University of Miami to Pay $22 Million to Resolve Allegations of Lab Test Fraud

Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders, Write Mary Inman and Max Voldman in RACMonitor

Financial Pressures on U.S. Hospitals, Combined with New Funding, Increase Risk of Medicare and Medicaid Fraud

The Financial Pressures on Hospitals in the COVID-19 Crisis

Top Ten Healthcare Fraud Recoveries of 2019

Is Data the Future of Whistleblowing?

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Catch of the Week — Florida Hospital Chain CEO Settles False Billing Allegations

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