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As States Look to Expand Health Coverage, State FCAs Become More Important than Ever

Posted 03/22/23

The increasing burden of healthcare costs has state governments looking at new programs to expand government healthcare options for their residents. Such an expansion of government spending will require a corresponding expansion of efforts to root out fraud, waste, and abuse that steals taxpayer dollars and reduces the benefits available. Existing anti-fraud measures, including state False Claims Acts, will play a...

Tagged in: FCA State, Government Programs Fraud, Healthcare Fraud, Medicaid, Medicare,

Healthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks

Posted 03/13/23

Very few cases ever filed reach jury trial. The vast majority are dismissed or settle long before that stage. This trend is particularly true for cases filed under the False Claims Act (FCA), where defendants face treble damages and penalties if they are found liable at trial. In FCA trials where the Government and/or whistleblower prevails, the judge, unbeknownst to the jury, is required to triple the amount of...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicare,

DOJ FY2022 Annual Fraud Report Shows $2.2 Billion in Total Recoveries, with $1.9 Billion Thanks to Whistleblowers - But There are Reasons for Concern

Posted 02/8/23

DOJ Headquarters building seen from low angle

The Department of Justice released its annual report of civil recoveries for fraud and false claims against the U.S., showing $2.2 billion in settlements and judgments for the fiscal year ending September 2022. The data released by DOJ show the critical role that whistleblowers play in securing these recoveries for the government: of the $2.2 billion recovered, $1.96 billion – 89% – was recovered in cases...

Tagged in: COVID-19, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, Statistics,

Top Ten Federal Financial and Healthcare Fraud Prison Sentences of 2022

Posted 02/2/23

Financial and healthcare fraud often can carry stiff monetary penalties for entities facing government enforcement, as shown on our other Top Ten Lists. Whistleblowers reporting wrongful conduct under one of the federal whistleblower reward laws sometimes find that criminal authorities are as interested in their allegations as civil enforcement agencies and authorities. Fraud can also result in criminal charges and...

Tagged in: Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Ponzi Schemes, Tax Fraud, Top 10, Visa Fraud,

Top Ten State Fraud Recoveries of 2022

Posted 01/19/23

State and local governments play a critical role in ensuring that businesses and individuals are held accountable if they commit healthcare fraud, financial fraud, government contract fraud, and more. For whistleblowers, state governments can offer additional opportunities to report wrongdoing. Where government funds are at stake – and state and local government spending reaching $3 trillion annually – more...

Tagged in: FCA State, Financial and Investment Fraud, Government Procurement Fraud, Healthcare Fraud, Housing and Mortgage Fraud, Medicaid, Money Laundering, Private Insurance Whistleblower Reward Programs, Top 10,

Top Ten Healthcare Fraud Recoveries of 2022

Posted 01/6/23

Healthcare fraud image showing stethoscope with gavel

Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

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,

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

Posted 08/24/22

Doctor with stethoscope on computer screen

Prior to the pandemic, telehealth was basically nonexistent, with one study clocking the percentage of “virtual” doctors’ visits before Covid-19 at zero percent. At the time, America’s largest insurer, Medicare, only covered telemedicine in limited circumstances that usually still involved a visit to a healthcare facility. Medicare’s coverage limitations demonstrated the Department of Health and Human...

Tagged in: COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Provider Fraud,

A recent case could undermine the rules that have been protecting taxpayer money from fraud since the time of Lincoln

Posted 06/24/22

Constantine Cannon whistleblower lawyers Eric Havian, Mike Ronickher, and Ari Yampolsky were published in Fortune.com on the Supreme Court's consideration of the SuperValu decision.

We’re whistleblower lawyers who spend our careers speaking in legalese. But every once in a while, a case comes along that is so alarming, yet so couched in jargon, that an issue of great importance can easily escape notice. When that...

Tagged in: CC Lawyers, Court Decision, Defenses, FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

American hospitals have been resistant to whistleblowers. Here’s how they can save money and lives by embracing them.

Posted 06/21/22

Last month, the American Hospital Association wrote a pointed letter to the Justice Department, asking them to investigate, and potentially sue, Medicare Advantage plans for improperly denying coverage of patients’ hospital services. Medicare Advantage is a popular government program that pays private insurers premiums to cover seniors, and the insurers are required by law to provide at least the same benefits as...

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers,

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As States Look to Expand Health Coverage, State FCAs Become More Important than Ever

Healthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks

DOJ FY2022 Annual Fraud Report Shows $2.2 Billion in Total Recoveries, with $1.9 Billion Thanks to Whistleblowers - But There are Reasons for Concern

Top Ten Federal Financial and Healthcare Fraud Prison Sentences of 2022

Top Ten State Fraud Recoveries of 2022

Top Ten Healthcare Fraud Recoveries of 2022

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

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

A recent case could undermine the rules that have been protecting taxpayer money from fraud since the time of Lincoln

Constantine Cannon whistleblower lawyers Eric Havian, Mike Ronickher, and Ari Yampolsky were published in Fortune.com on the Supreme Court's consideration of the SuperValu decision.

American hospitals have been resistant to whistleblowers. Here’s how they can save money and lives by embracing them.

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