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“Widespread and Persistent” Problems in Medicare Managed Care Burden Patients and Are Potential Violations of the False Claims Act

Posted 10/30/18

The federal government’s internal watchdog for the Medicare and Medicaid healthcare programs, the U.S. Department of Health and Human Services Office of the Inspector General (OIG), has issued a report finding that Medicare Advantage Organizations (MAOs) have engaged in a “widespread and persistent” practice of inappropriately denying coverage for medical services to Medicare patients. In addition, OIG has...

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Medicare,

Overpayment Rule Decision Doesn't Imperil Risk Adjustment Cases: Mary Inman and Max Voldman in RAC Monitor

Posted 10/19/18

On September 7, a federal district court in Washington, D.C. vacated a single Centers for Medicare & Medicaid Services regulation – the 2014 “overpayment rule.” As Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman write in RAC Monitor, many Medicare Advantage Organizations have since made bold statements about the significance of this decision and its impact on the series of False Claims...

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

Healthcare Fraud: it’s not just Medicare and Medicaid

Posted 10/17/18

Last year, the U.S. Department of Justice recovered $2.4 billion in settlements and judgments involving fraud in the healthcare industry perpetrated against government payors. But government programs like Medicare and Medicaid aren’t the only targets of massive healthcare fraud schemes. A recent Department of Justice press release announced the unsealing of a 32-count indictment containing charges against four...

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

Catch of the Week – AmerisourceBergen Corporation

Posted 10/12/18

Last Monday, one of the largest drug wholesalers in the country agreed to pay $625 million to settle allegations that it put cancer patients at risk by illegally repackaging and distributing millions of vials of oncology drugs. The federal government and forty-four states claimed that AmerisourceBergen Corp. (“ABC”) and one of its subsidiaries, Medical Initiatives, Inc. (“MII”) engaged in a thirteen-year-long...

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

Catch of the Week — Health Management Associates

Posted 09/27/18

Health Management Associates, LLC (“HMA”), a former hospital chain now part of Community Health Systems, agreed on September 25th to a $260 million settlement to resolve allegations of false billing and kickbacks alleged in eight qui tam cases under the False Claims Act (“FCA”). HMA was a hospital chain headquartered in Tampa, Florida that was acquired by Community Health Systems Inc., a major U.S. hospital...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

What Would You Do? Disgrace and Conflicts in Medical Clinical Studies

Posted 09/18/18

The fall and resignation of the renowned Chief Medical Officer and physician-in-chief of Memorial Sloan Kettering Cancer Center, researcher Dr. Jose Baselga, once again sound the alarm of questionable ethics, conflicts of interest, and integrity in clinical studies. Dr. Baselga is known as one of the world’s top cancer doctors, credited with new, life-saving therapies. Drug companies sponsor interested...

Tagged in: FDA Fraud, Pharma Fraud, What Would You Do?,

Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica

Posted 09/7/18

Whistleblower Marc Silver secured a victory from the Third Circuit on September 4, 2018, which held that his action was not blocked by the “public disclosure bar” of the False Claims Act, reversing a lower court that had dismissed his action. The Third Circuit’s opinion appropriately recognizes that a whistleblower can use non-public information as a bridge between public information and allegations of fraud,...

Tagged in: Anti-Kickback and Stark, Court Decision, FCA Federal, Healthcare Fraud, Medicaid, Part D, Pharma Fraud, Public Disclosure and Public Information,

Catch of the Week — Ambulance Company and Clients Busted for Illegal Kickbacks and Cozy Financial Relationships

Posted 08/31/18

Here’s a question you shouldn’t have to ask when you’re in an ambulance: Did a bribe put me here? Our Catch of the Week goes to a $21 million settlement of a case against several ambulance-industry companies for allegedly paying kickbacks to secure lucrative exclusive contracts. Paramedics Plus, the East Texas Medical Center, the Emergency Medical Services Authority (EMSA), and EMSA’s president and CEO Herbert...

Tagged in: Ambulance, Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

Inman writes on whistleblower case brought by outsider

Posted 08/30/18

Constantine Cannon partner Mary Inman published an article in RAC Monitor about a lawsuit brought against Providence Health & Services and its consultant J.A. Thomas and Associates LLC (JATA) by Integra Med Analytics LLC, a data analysis firm that uses statistical analysis of publicly available data to attempt to uncover and prove fraud. Integra alleged that it analyzed seven years’ worth of publicly-available...

Tagged in: FCA Federal, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Eligibility,

AstraZeneca Settles Seroquel False Claims Action -- Again

Posted 08/9/18

On August 8, 2018, AstraZeneca agreed to pay $110 million to the state of Texas to settle allegations that it promoted two of its drugs without FDA approval resulting in health risks to children, adolescents, and other state hospital patients. This case was brought by two whistleblowers under the qui tam provisions of Texas’s Medicaid Fraud Prevention Act. The whistleblowers, two former AstraZeneca employees, among...

Tagged in: FCA State, FDA Fraud, Healthcare Fraud, Medicaid, Multiple Whistleblowers and First-to-File, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

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“Widespread and Persistent” Problems in Medicare Managed Care Burden Patients and Are Potential Violations of the False Claims Act

Overpayment Rule Decision Doesn't Imperil Risk Adjustment Cases: Mary Inman and Max Voldman in RAC Monitor

Healthcare Fraud: it’s not just Medicare and Medicaid

Catch of the Week – AmerisourceBergen Corporation

Catch of the Week — Health Management Associates

What Would You Do? Disgrace and Conflicts in Medical Clinical Studies

Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica

Catch of the Week — Ambulance Company and Clients Busted for Illegal Kickbacks and Cozy Financial Relationships

Inman writes on whistleblower case brought by outsider

AstraZeneca Settles Seroquel False Claims Action -- Again

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