Question of the Week — Will Healthcare Settlements Continue to Dominate False Claims Act Recoveries?
Posted 07/24/19
Recent blockbuster settlements continue past trends: healthcare fraud has so far this year dominated FCA recoveries. During the first half of 2019, the Department of Justice (“DOJ”) secured over $750 million in settlements from False Claims Act (“FCA”) cases. And just past the mid-year point, total recoveries have nearly doubled due to a $700 million civil settlement ($1.4 billion total) entered on July 11th...
Government Documents Dangerous Failures in Hospice-Care Facilities
Posted 07/19/19
The Department of Health and Human Services (HHS) recently released two deeply concerning reports about failures in hospice care. Hospices put patients in harm’s way by failing to meet Medicare’s standards of care, failing to protect patients from abuse, and failing to report dangerous conditions. All told, the reports paint a grim picture of substandard health services for a particularly vulnerable patient...
Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?
Posted 07/12/19
On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...
New York Introduces Bills to Expand Whistleblower Protections
Posted 06/21/19
Under current law, whistleblowers who reported fraudulent activity in the government or other settings in the State of New York are typically barred from bringing other legal actions. Maybe not anymore. Last week, both the New York State Senate and Assembly signed off on a series of amendments aimed at providing greater protection for employees who notice and report illegal activity, and expanding the definition of a...
Question of the Week — Should providers who defraud Medicare be excluded from it?
Posted 06/18/19
Sometimes, though rarely, when a medical provider settles a False Claims Act case or is found to have violated the FCA at trial, they are excluded from participating in healthcare programs as a condition of resolving the case. Often, this is a limited-time ban that is meant to incentivize providers to follow Medicare’s rules in the future and to deter other providers from committing fraud.
Between Medicare,...
Question of the Week — Is it time for a legislative fix to limit sky high air ambulance costs?
Posted 06/14/19
As rural hospitals continue to shutter, accessible emergency medical care is out of reach for an increasing number of Americans. When health emergencies arise, patients in rural communities often must rely on helicopter ambulances to get them quickly to care. But the Government Accountability Office reported the median cost for a helicopter ambulance ride was over $36,000 in 2017.
The problem will likely continue...
Catch of the Week — Wound Care Device Manufacturer ACell Inc.
Posted 06/14/19
Our Catch of the Week goes to ACell Inc., a Maryland-based medical device manufacturer that pleaded guilty to violating the Federal Food, Drug, and Cosmetic Act (FDCA) by failing to report that it had partially removed its wound-care product, MicroMatrix, from the market because it was contaminated with endotoxins, placing treated patients in danger of serious infection, even death, without informing the FDA that it...
Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?
Posted 06/7/19
Opioid manufacturer Insys Therapeutics agreed to a $225 million settlement related to allegations that it unlawfully marketed its drug Subsys and paid kickbacks to providers through “speaker programs” that rewarded providers who prescribed Subsys. We previously asked whether our readers thought CEOs should be more liable for corporate wrongdoing after the Insys CEO was convicted for participating in a criminal...
Default by Nursing Home Chain on HUD-Guaranteed Mortgage Highlights Potential for Fraud in Section 232 Program
Posted 06/3/19
Last week, the New York Times reported on the collapse of Rosewood Care Centers, a chain of nursing homes with facilities in Illinois and Missouri. According to the report, the chain had faced years of operational and financial difficulties, including fines by state regulators, personal injury claims by residents, and lawsuits by investors and vendors.
When it went under, Rosewood defaulted on $146 million in...
This week's DOJ Catch of the Week goes to Kansas cardiologist Joseph Galichia. Yesterday, he agreed to pay $5.8 million to resolve allegations that he and his company, Galichia Medical Group, violated the False Claims Act by billing federal health care programs for medically unnecessary cardiac stent procedures. This is the government's third False Claims Act settlement with Dr. Galichia. Which may explain why he also...