Contact

Click here for a confidential contact or call:

1-212-350-2764

Archive

Page 1 of 5

Constantine Cannon Settles Case Alleging Kickbacks to Multi-Practice Physicians’ Group for Referrals to Wholly Owned Ambulatory Surgery Center – Whistleblower Was Former CEO

Posted  10/9/20
doctor operating with nurse
Constantine Cannon, on behalf of whistleblower Jeffery Neuberger, has settled a False Claims Act action against Mid Dakota Clinic and a related entity.  Mr. Neuberger, the former CEO of the medical group, filed his case in 2017 alleging a scheme in violation of the Anti-Kickback Statute (AKS) between the medical group and its wholly owned ambulatory surgery center (ASC).  At issue was a financial arrangement whereby...

Catch of the Week: 345 Charged in $6 Billion National Health Care Fraud and Opioid Takedown

Posted  10/2/20
Paper Ripped Uncovering Medical Necessity Wording
In the largest health care fraud and opioid enforcement action in the Justice Department’s history, 345 defendants—including more than 100 doctors, nurses, and other medical professionals—face charges for submitting over $6 billion in false or fraudulent claims to federal and private insurers.  Defendants stand accused of submitting $4.5 billion in fraudulent claims linked to telemedicine, $845 million...

Windfall to Health Insurers Due to COVID-19 Is Not Yet Resulting in Resolution of FCA Risk Adjustment Cases

Posted  08/21/20
As health insurers book record profits during the COVID-19 pandemic due to a dramatic decline in elective surgeries and procedures, this seems like a good time to ask about the status of False Claims Act litigation against Medicare Advantage Organizations (MAOs) relating to risk adjustment fraud.  Given the dire shortfall in state and federal money to fight the pandemic, when will MAOs begin paying back the billions...

Whistleblowers Are Critical to Exposing Fraud in the Murky World of For-Profit and Private-Equity Nursing Home Operations

Posted  07/17/20
person following a trail of money
The settlement of a fraud case against 27 skilled nursing facilities controlled by private owners demonstrates “the power of whistleblowers to shine a light on improper business practices and obtain significant recoveries on behalf of United States taxpayers.”  (U.S. Attorney Nick Hanna, C.D. California.)  The government’s recognition of the contributions of whistleblowers in the False Claims Act case against...

Under Cover of Pandemic, Nursing Home Residents Illegally Evicted

Posted  06/26/20
wheelchair in the hospital lobby
“It felt opportunistic, where some homes were basically seizing the moment when everyone is looking the other way to move people out.”  (Laurie Facciarossa Brewer, long-term care ombudsman in New Jersey).  With nursing homes involved in more than 40% of coronavirus deaths, in depth reporting by Jessica Silver-Greenberg and Amy Julia Harris at the New York Times reveals a new threat to residents’ care and...

Medicare Risk Adjustment Fraud is Not Victimless

Posted  06/18/20
medicare dollars
Implicit in the arguments made by many Medicare Advantage Organizations (MAOs), health plans, hospital networks and other defendants in response to whistleblower and government False Claims Act complaints is that the alleged misconduct—falsifying diagnosis data so that CMS overpays for patients enrolled in an MA plan—involves just a technical record-keeping or administrative dispute with CMS and no actual...

Increased Federal Funds, Incentives, and Requirements for Nursing Homes Brings Worrisome Opportunities for Fraud

Posted  06/5/20
wheelchair in the hospital lobby
The pandemic has exposed the razor thin margin for error by which our most vulnerable are cared for in nursing homes. New aggregate federal data reveal the appalling toll on facility residents and staff: over 31,700 deaths as of June 4, 2020 (an undercounted 1/3 of all US COVID-19 deaths), according to the federal government’s Nursing Home Compare.  Responsive federal funding for nursing homes, requirements for...

Private Equity Ownership of Nursing Homes Might Have Made Everything Worse

Posted  05/15/20
person pocketing money in a business suit
Most nursing homes already had no room for error before COVID-19.  Years of private equity ownership and competition with other elder-care services dealt a one-two punch to the cash-strapped facilities’ ability to react to the pandemic crisis, says The New York Times in a troubling analysis.  In particular, private equity firms’ relentless quest for profits, miniscule margins, and regular cash-draining...

Let’s Talk about Nursing Homes – Who Will Raise the Red Flag Now That Routine Inspections Are Halted?

Posted  05/14/20
nurse checking on elder woman
In March 2020, the federal government abruptly paused non-emergency inspections of some 15,300 nursing homes and other long-term healthcare facilities nationwide in order to focus on preparations to respond to the threat of COVID-19 pandemic.  This triage means that an on-site survey will be authorized only in cases of “immediate jeopardy” of serious harm (e.g., abuse) or reported infection-control...

New Lawsuit Against Anthem Shows the Government’s Commitment to Medicare Advantage Fraud

Posted  04/3/20
health insurance with stethoscope and hundred dollar bills
Medicare Advantage, also called Medicare Part C, is ever-expanding part of our healthcare system. The program now insures over a third of total Medicare beneficiaries, well over 10 million people. An expansion in fraud has accompanied the program’s expansion, and the Department of Justice is zeroing in, with the Assistant Attorney General for the Civil Division, Joseph Hunt, recently declaring it a...
1 2 3 4 5

Newsletter

Subscribe to receive email updates from the Constantine Cannon blogs

Sign up for: