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New York Times Covers “Cash Monster” of Risk Adjustment Fraud, Featuring Cases Initiated by Constantine Cannon Clients

Posted 10/11/22

Kaiser whistleblower Dr. James Taylor got the headline on the front page of Sunday’s New York Times: “The cash monster was insatiable.” The article, subtitled How Insurers Exploited Medicare for Billions, highlights that nearly half of the Medicare beneficiaries in the U.S. are now enrolled in Medicare Advantage programs. Federal payments to Medicare Advantage insurers make up a correspondingly increasing share...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Managed Care, Risk Adjustment Fraud,

DOJ Announces $5.7 Billion in FCA Recoveries in Fiscal Year 2021, with Boost from Purdue Settlement Claim

Posted 02/2/22

DOJ has released its annual announcement of recoveries in civil cases involving fraud and false claims against the government, and the total recoveries are eye-popping: $5.65 billion in settlements and judgments. These recoveries make FY2021 the second largest year in False Claims Act history, and the largest since 2014. As in prior years, healthcare fraud dominated, with more than $5 billion of the total...

Tagged in: FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, Managed Care, Statistics,

Catch of the Week: CMS Suspends UnitedHealth and Anthem Medical Advantage Plans for Charging Too Much in Premiums

Posted 09/24/21

CMS suspended three UnitedHealth Medicare Advantage (MA) plans and one Anthem MA plan this week for failing to meet federal Medical Loss Ratio requirements. The four plans – United of the Midwest, United of New Mexico, United of Arkansas, and Anthem’s MMM Healthcare – are prohibited from enrolling new members until 2023. MMM Healthcare is the largest MA plan in Puerto Rico, with more than 260,000...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Managed Care, Medicare,

U.S. Pursuit of Risk Adjustment Fraud Continues with Complaint in Intervention in Case Filed by Constantine Cannon Client against Independent Health and its Coding Subsidiary DxID

Posted 09/16/21

Western District of New York Birds-Eye View of Building

In July, we wrote that managed care enforcement had reached a “tipping point,” as the Department of Justice intervened in whistleblower cases against Kaiser Permanente alleging risk adjustment fraud, including a case brought by Constantine Cannon client Dr. James Taylor. Just last month, we announced a $90 million settlement in a different Medicare Advantage risk adjustment fraud case brought by Constantine...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Managed Care, Risk Adjustment Fraud, Whistleblower Case,

Constantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference

Posted 09/10/21

stethoscope on top of hundred dollars bills scattered around

Building on Constantine Cannon’s reputation as the preeminent law firm representing whistleblowers in FCA cases involving Medicare Advantage (MA) risk adjustment fraud, three Constantine Cannon attorneys, Mary Inman, Ed Baker, and Max Voldman, recently presented on case developments in this fast-developing area of the law at RISE West, a national conference for healthcare professionals working in the managed care...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Managed Care, Medicare, Provider Fraud, Risk Adjustment Fraud, Whistleblower Case,

Managed Care Risk Adjustment Enforcement Continues with Sutter Health Settlement: Constantine Cannon Client Secures Largest Ever Medicare Advantage Settlement by a Hospital

Posted 08/30/21

Sutter Health will pay the Government $90 million under the False Claims Act for allegedly submitting inaccurate and unsupported medical information on tens of thousands of patients. The settlement in a case brought by a whistleblower represented by Constantine Cannon, together with co-counsel Keller Grover and Kleiman Rajaram, is the largest Medicare Advantage FCA settlement against a hospital system, and the...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Managed Care, Provider Fraud, Risk Adjustment Fraud, Whistleblower Case,

Media Coverage of Government Intervention in Kaiser Medicare Advantage Suits: LA Times says Cases Point to a “Massive Fraud Problem in Medicare”

Posted 08/6/21

As we announced last week, the U.S. Department of Justice gave notice that it was intervening in six different False Claims Act lawsuits against Medicare Advantage organization Kaiser Permanente and its affiliated entities, including a whistleblower lawsuit filed by Constantine Cannon’s whistleblower client, James Taylor, M.D. The government’s decision received extensive coverage in the media, with Los Angeles...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Managed Care, Risk Adjustment Fraud, Upcoding,

United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente

Posted 07/30/21

In a sign that the government’s enforcement efforts against fraud in the Medicare managed care system have reached a tipping point, the U.S. Department of Justice announced today that it is joining a portion of a whistleblower lawsuit brought by a Constantine Cannon client under the False Claims Act against Kaiser Permanente and affiliated entities, one of the nation’s largest managed-care organizations. ...

Tagged in: CC Lawyers, FCA Federal, Government Decision, Healthcare Fraud, Managed Care, Medicare, Risk Adjustment Fraud, Upcoding, Whistleblower Case,

Catch of the Week: Roche and Humana Agree to Settle Kickbacks in the Medicare Advantage Program

Posted 02/9/21

A recent settlement of a whistleblower case might be a sign of things to come for litigation under the False Claims Act (FCA) in the whistleblower program. Pharmaceutical company, Roche, and Medicare Advantage insurer, Humana, have agreed to pay $12.5 million to resolve allegations that the companies violated the anti-kickback statute. This is the first FCA settlement resulting out of a pharmaceutical company...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Managed Care, Medicare, Whistleblower Case,

Constantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.

Posted 11/17/20

health insurance forms with stethoscope and calculator

Teresa Ross, a whistleblower represented by Constantine Cannon, and the Department of Justice have reached a settlement with Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative or GHC). The Medicare Advantage Organization (MAO) has agreed to pay $6.375 million to resolve allegations that the insurance plan improperly collected money from the Medicare Advantage program by overstating how...

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Medical Billing Fraud, Medicare, Risk Adjustment Fraud, Whistleblower Case, Whistleblower Rewards,

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New York Times Covers “Cash Monster” of Risk Adjustment Fraud, Featuring Cases Initiated by Constantine Cannon Clients

DOJ Announces $5.7 Billion in FCA Recoveries in Fiscal Year 2021, with Boost from Purdue Settlement Claim

Catch of the Week: CMS Suspends UnitedHealth and Anthem Medical Advantage Plans for Charging Too Much in Premiums

U.S. Pursuit of Risk Adjustment Fraud Continues with Complaint in Intervention in Case Filed by Constantine Cannon Client against Independent Health and its Coding Subsidiary DxID

Constantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference

Managed Care Risk Adjustment Enforcement Continues with Sutter Health Settlement: Constantine Cannon Client Secures Largest Ever Medicare Advantage Settlement by a Hospital

Media Coverage of Government Intervention in Kaiser Medicare Advantage Suits: LA Times says Cases Point to a “Massive Fraud Problem in Medicare”

United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente

Catch of the Week: Roche and Humana Agree to Settle Kickbacks in the Medicare Advantage Program

Constantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.

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