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Question of the Week — Are device manufacturer's services valuable education or unlawful kickbacks?

Posted 03/13/19

Person in scrubs and gloves holding medical device on draped table

Earlier this week, medical-device manufacturer Medtronic's Covidien business unit agreed to pay approximately $20 million to resolve kickback allegations related to the sale of its ClosureFast radiofrequency ablation catheters. ClosureFAST catheters are used in procedures to treat venous-reflux disease, whose symptoms include varicose veins. The settlement resolves claims that Covidien improperly provided doctors...

Tagged in: Anti-Kickback and Stark, Question of the Week,

$2.1 Million Whistleblower Settlement with Skyline Urology Resolves Allegations of Improper Unbundling Fraud

Posted 03/1/19

This week, the Department of Justice and Constantine Cannon LLP announced a $2.1 million settlement against Skyline Urology, at one time the largest urology practice in California. The settlement, which includes $1.85 million to the United States and $250,000 to the State of California, resolved allegations by our whistleblower client that Skyline had engaged in a systematic coding scheme to defraud Medicare and...

Tagged in: Bundling and Unbundling, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

Ohio Seeks to Recover Overcharges from OptumRx

Posted 02/21/19

After a 2018 investigation by the Ohio Bureau of Workers Compensation (BWC) of its prescription drug spending, the BWC pharmacy program manager, John Hanna, concluded that "we were being hosed." The BWC had contracted with OptumRx to act as a pharmacy benefits manager (PBM). PBMs act as middlemen between drugmakers, pharmacies, and payors such as worker's compensation programs, Medicaid, Medicare, and other...

Tagged in: FCA State, Medicaid, Other Government Health Programs, Pharma Fraud,

Data Whistleblower Case Raises Question of What is a Public Disclosure

Posted 02/21/19

Rows of chairs with people waiting in hospital billing office

As regular readers know, we have been closely tracking the progress of data analysis firm Integra Med Analytics’ whistleblower lawsuit under the False Claims Act against Providence Health and its consultant J.A. Thomas and Associates, Inc. (JATA). The case alleges a conspiracy between Providence and JATA to upcode for specific Major Complications or Comorbidities (MCCs). This case is part of a growing number of...

Tagged in: Court Decision, FCA Federal, Healthcare Fraud, Hospital Fraud, Public Disclosure and Public Information, Upcoding, Whistleblower Case,

Catch of the Week – Justice Department Sues Tennessee Pharmacies and Pharmacists Illegally Dispensing Opioids

Posted 02/11/19

Stethoscope with computer tablet saying "Opiod epidemic"

On Friday, the Justice Department announced that it has sued several pharmacies and pharmacists in Tennessee to stop them from illegally dispensing opioids. According to the complaint, both defendants have “fueled and profited from” the opioid epidemic by “repeatedly dispensing opioids and other controlled substances prone to abuse without a legitimate medical purpose and outside the usual course of professional...

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

Catch of the Week – EHR Developer Greenway Health to Pay $57.25 Million to Settle FCA Allegations

Posted 02/8/19

Person in scrubs holding computer tablet projecting medical data

Electronic health records (EHR) software developer Greenway Health LLC agreed to pay $57.25 million to resolve allegations that it committed fraud by misrepresenting to its users the capabilities of its EHR product “Prime Suite” and by providing unlawful remuneration to users to induce them to recommend Prime Suite. Under the American Recovery and Reinvestment Act of 2009, the government made incentive payments...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Contract Non-Compliance, Electronic Health Records, FCA Federal, Healthcare Fraud,

Catch of the Week – Inform Diagnostics

Posted 02/1/19

Technician in laboratory safety wear using eyedropper to fill vials of blood

Texas-based pathology laboratory company Inform Diagnostics, formerly known as Miraca Life Sciences Inc., agreed on January 30th to a $63.5 million settlement to resolve allegations it violated the False Claims Act (“FCA”), the Anti-Kickback Statute (“AKS”), and the Stark Law by providing subsidies to referring physicians for electronic health record (“EHR”) technology as well as free or discounted...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Electronic Health Records, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Multiple Whistleblowers and First-to-File, Whistleblower Case,

New Yorker Article on Whistleblowers Features Constantine Cannon

Posted 01/28/19

Silver whistle hanging on cord in front of chalkboard

In an article titled “The Personal Toll of Whistle-Blowing” published in the February 4, 2019, New Yorker magazine, Sheelah Kolhatkar describes the cases of two Constantine Cannon whistleblower clients, and features whistleblower attorney Mary Inman. Focusing on False Claims Act cases involving fraud in the Medicare Advantage program, the article details how the FCA “effectively turned average citizens into a...

Tagged in: CC Lawyers, FCA Federal, Importance of Whistleblowers, Managed Care, Risk Adjustment Fraud,

Top Ten Federal False Claims Act Recoveries of 2018

Posted 01/28/19

The federal False Claims Act, under which whistleblowers can bring claims to report fraud and misconduct in government contracts and programs, is the foundation of the Department of Justice's fraud recovery and the U.S. whistleblower reward system. In 2018, the U.S. recovered over $2 billion from defendants who sought to cheat the system. The top FCA settlements for calendar year 2018, based on the amount of the...

Tagged in: FCA Federal, Government Procurement Fraud, Healthcare Fraud, Top 10, Whistleblower Rewards,

Top Ten State Fraud Recoveries of 2018

Posted 01/25/19

Political map of continental United States with states outlined

While 2018 saw many important federal settlements and whistleblower awards across a wide range of industries, state governments were equally busy rooting out fraud. In fact, in the last few years, recognizing the ever-growing need to hold businesses accountable for defrauding taxpayers, several states have passed their own false claims statutes modeled after the federal false claims act. These laws operate in a...

Tagged in: Financial and Investment Fraud, Healthcare Fraud, Top 10,

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Question of the Week — Are device manufacturer's services valuable education or unlawful kickbacks?

$2.1 Million Whistleblower Settlement with Skyline Urology Resolves Allegations of Improper Unbundling Fraud

Ohio Seeks to Recover Overcharges from OptumRx

Data Whistleblower Case Raises Question of What is a Public Disclosure

Catch of the Week – Justice Department Sues Tennessee Pharmacies and Pharmacists Illegally Dispensing Opioids

Catch of the Week – EHR Developer Greenway Health to Pay $57.25 Million to Settle FCA Allegations

Catch of the Week – Inform Diagnostics

New Yorker Article on Whistleblowers Features Constantine Cannon

Top Ten Federal False Claims Act Recoveries of 2018

Top Ten State Fraud Recoveries of 2018

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