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Catch of the Week: CMS Suspends UnitedHealth and Anthem Medical Advantage Plans for Charging Too Much in Premiums

Posted  09/24/21
Medicare Card
CMS suspended three UnitedHealth Medicare Advantage (MA) plans and one Anthem MA plan this week for failing to meet federal Medical Loss Ratio requirements. The four plans – United of the Midwest, United of New Mexico, United of Arkansas, and Anthem’s MMM Healthcare – are prohibited from enrolling new members until 2023. MMM Healthcare is the largest MA plan in Puerto Rico, with more than 260,000...

U.S. Pursuit of Risk Adjustment Fraud Continues with Complaint in Intervention in Case Filed by Constantine Cannon Client against Independent Health and its Coding Subsidiary DxID

Posted  09/16/21
Western District of New York Birds-Eye View of Building
In July, we wrote that managed care enforcement had reached a “tipping point,” as the Department of Justice intervened in whistleblower cases against Kaiser Permanente alleging risk adjustment fraud, including a case brought by Constantine Cannon client Dr. James Taylor.  Just last month, we announced a $90 million settlement in a different Medicare Advantage risk adjustment fraud case brought by Constantine...

Constantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference

Posted  09/10/21
stethoscope on top of hundred dollars bills scattered around
Building on Constantine Cannon’s reputation as the preeminent law firm representing whistleblowers in FCA cases involving Medicare Advantage (MA) risk adjustment fraud, three Constantine Cannon attorneys, Mary Inman, Ed Baker, and Max Voldman, recently presented on case developments in this fast-developing area of the law at RISE West, a national conference for healthcare professionals working in the managed care...

Managed Care Risk Adjustment Enforcement Continues with Sutter Health Settlement: Constantine Cannon Client Secures Largest Ever Medicare Advantage Settlement by a Hospital

Posted  08/30/21
Sutter Health will pay the Government $90 million under the False Claims Act for allegedly submitting inaccurate and unsupported medical information on tens of thousands of patients.  The settlement in a case brought by a whistleblower represented by Constantine Cannon, together with co-counsel Keller Grover and Kleiman Rajaram, is the largest Medicare Advantage FCA settlement against a hospital system, and the...

Media Coverage of Government Intervention in Kaiser Medicare Advantage Suits: LA Times says Cases Point to a “Massive Fraud Problem in Medicare”

Posted  08/6/21
Headshots of attorneys Edward Baker, Mary Inman, and Michael Ronickher
As we announced last week, the U.S. Department of Justice gave notice that it was intervening in six different False Claims Act lawsuits against Medicare Advantage organization Kaiser Permanente and its affiliated entities, including a whistleblower lawsuit filed by Constantine Cannon’s whistleblower client, James Taylor, M.D.  The government’s decision received extensive coverage in the media, with Los Angeles...

United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente

Posted  07/30/21
Kaiser Permanente Building with Logo
In a sign that the government’s enforcement efforts against fraud in the Medicare managed care system have reached a tipping point, the U.S. Department of Justice announced today that it is joining a portion of a whistleblower lawsuit brought by a Constantine Cannon client under the False Claims Act against Kaiser Permanente and affiliated entities, one of the nation’s largest managed-care organizations. ...

Catch of the Week: Roche and Humana Agree to Settle Kickbacks in the Medicare Advantage Program

Posted  02/9/21
briefcase of cash
A recent settlement of a whistleblower case might be a sign of things to come for litigation under the False Claims Act (FCA) in the whistleblower program. Pharmaceutical company, Roche, and Medicare Advantage insurer, Humana, have agreed to pay $12.5 million to resolve allegations that the companies violated the anti-kickback statute. This is the first FCA settlement resulting out of a pharmaceutical company...

Constantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.

Posted  11/17/20
health insurance forms with stethoscope and calculator
Teresa Ross, a whistleblower represented by Constantine Cannon, and the Department of Justice have reached a settlement with Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative or GHC).  The Medicare Advantage Organization (MAO) has agreed to pay $6.375 million to resolve allegations that the insurance plan improperly collected money from the Medicare Advantage program by overstating how...

Catch of the Week: Logan Laboratories and Tampa Pain Relief Centers for Urine Drug Testing Fraud

Posted  04/17/20
Doctor with Cash
This week's Catch of the Week goes to Logan Laboratories, Inc. (Logan Labs), a reference laboratory in Tampa, Florida. Tampa Pain Relief Centers, Inc. (Tampa Pain), a pain clinic also based in Tampa, Florida, and two of their former executives who have agreed to pay a total of $41 million to resolve alleged violations of the False Claims Act for billing various federal health care programs for medically unnecessary...

Federal Audit Reveals Billions of Dollars in Medicare Advantage Overpayments

Posted  12/20/19
A new government report reveals what whistleblowers and their counsel have known for some time: the Medicare Advantage program is vulnerable to fraud committed by unscrupulous private health insurance companies, as well as their owners, vendors, affiliates, and even some doctors.  These bad actors make patients enrolled in MA plans appear sicker than they actually are in order to increase their corporate profits. ...
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