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Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders, Write Mary Inman and Max Voldman in RACMonitor

Posted  06/10/20
attorney headshots of Mary Inman and Max Voldman
Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman updated their earlier reporting in RAC Monitor regarding the False Claims Act case brought by Integra Med Analytics against Texas-based hospital chain Baylor Scott & White.  At the end of May, the Fifth Circuit Court of Appeals upheld a Texas district court opinion dismissing the case. As we have earlier written, Integra alleged that the...

Financial Pressures on U.S. Hospitals, Combined with New Funding, Increase Risk of Medicare and Medicaid Fraud

Posted  05/22/20
Multistory hospital building set amid trees
Hospitals are an institution we might have expected to be prepared for a healthcare crisis.  It is their job, after all, to provide emergency and intensive healthcare.  In fact, however, the COVID-19 crisis has put enormous pressures on hospitals.  With such new pressures come new risks of healthcare fraud at hospitals.

The Financial Pressures on Hospitals in the COVID-19 Crisis

Against the backdrop of heroic...

Top Ten Healthcare Fraud Recoveries of 2019

Posted  01/24/20
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters.  And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act.  Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...

Is Data the Future of Whistleblowing?

Posted  08/28/19
Two recent decisions, one in California and the other in Texas, might be signaling a new frontier in False Claims Act (FCA) litigation: the data-driven whistleblower. Both cases are brought by the same whistleblower, Integra. Integra is not a typical whistleblower, which are generally corporate insiders or other employees of a company that is accused of defrauding the government. Instead, Integra is a corporation that...

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Posted  05/24/19
Doctor Holding Heart in Palms
Earlier this month, a Utah-based hospital chain announced it would settle whistleblower Dr. Gerald Polukoff’s case alleging the hospital performed unnecessary heart surgeries on Medicare patients, thereby overcharging the federal government in violation of the False Claims Act (FCA). Defendant Intermountain Health, the largest healthcare provider in the Intermountain West, had petitioned the U.S. Supreme Court to...

Catch of the Week — Florida Hospital Chain CEO Settles False Billing Allegations

Posted  05/3/19
Emergency Room Hospital with Night Lights On
This week’s Catch of the Week highlights former hospital executive Gary D. Newsome’s settlement resolving false billing and kickback allegations. From 2008 to 2013, Newsome served as CEO of Naples, Florida-based hospital chain Health Management Associates, LLC (HMA). He will pay $3.46 million to resolve federal prosecutors’ claims that HMA, under his leadership, pressured doctors in the emergency department to...

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...

Top Ten Healthcare Recoveries of 2018

Posted  01/15/19
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2018 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Here are the top ten healthcare recoveries of 2018 by the numbers:
    1. Amerisource Bergen Corporation - In...

Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

Posted  12/14/18
Doctor discussing knee injury with patient seated on exam table
Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act for submitting false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health is a for-profit hospital and health system based in the Lehigh...

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...
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