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Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Recent Settlements Show Kickbacks are Always a DOJ Enforcement Priority

Posted  11/15/21
Person Handing Hundred Dollar Bill to Another Person
The Department of Justice regularly highlights the areas of fraudulent conduct it intends to target as enforcement priorities.  These identified enforcement priorities tend to cover burgeoning areas of fraud or particular misbehavior especially ripe or prevalent because of the particular times we live in.  As might be expected, DOJ's current listing of priorities includes fraud related to the pandemic, opioids, the

Catch of the Week: Fraudulent Sleep Tests in Fresno

Posted  10/29/21
bed with pillow and sheets scattered
Fraud permeates through all aspects of America’s healthcare system- from hospitals to big pharma to chiropractors. This week’s catch of the week focuses on another part of the system, sleep clinics. As increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders, the significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous...

Catch of the Week: Telemedicine Company Owner Charged in $784 Million Kickback Scheme

Posted  08/20/21
Doctor on computer with patient discussing medicine
Underscoring the fraud risks associated with the government’s continued expansion and loosening of restrictions on telehealth, the U.S. Department of Justice recently announced that a grand jury in New Jersey has returned a superseding indictment against the Florida owner of multiple telemedicine companies, referred to by DOJ prosecutors as the Video Doctor Network, for allegedly participating in a massive Medicare...

Catch of the Week: Waived Copayments and “Free” Glucometers Result in $160 Million Recovery in Whistleblower Action Against Previously-Barred Arriva Medical

Posted  08/4/21
Woman using glucometer and diabetes testing strips
Mail-order diabetes supply company Arriva Medical has agreed to pay $160 million to resolve a False Claims Act case filed in 2013 by a whistleblower who worked for ten months in one of the company’s call centers.  The government intervened in the whistleblower’s action in early 2019, and the case had been set for trial in June 2022. The settlement is the latest in a long string of actions against Arriva and...

Catch of the Week: Medical Device Companies to Pay $38.75M Over Defective Coagulation Monitor Allegations Linked to Patient Deaths, Injuries

Posted  07/9/21
tubes of blood
Medical device manufacturers Alere Inc. and Alere San Diego Inc. will pay nearly $40 million to resolve allegations that they knowingly sold defective blood coagulation monitors used by Medicare beneficiaries and falsely billed Medicare for the devices. The monitors are supposed to ensure that patients taking anticoagulant drugs receive a safe dosage to avoid life-threatening consequences from too much or too little...

P-Stim Fraud: A New DOJ Enforcement Priority?

Posted  04/23/21
The Department of Justice regularly publicizes its fraud prevention and False Claims Act enforcement priorities. These announced priorities typically focus on broad issues that affect the lives of millions of Americans – COVID-19 fraud, the opioid crisis, and the rapid expansion of telehealth.  In addition, we keep an eye on DOJ enforcement actions, and these can reveal emerging trends, often in narrow areas.  One...

Operation Brace Yourself Nets $20M Settlement with DME Fraudster

Posted  02/9/21
stethoscope and blood pressure
This week, the Department of Justice announced it had reached a $20.3 million settlement with a Florida businesswoman who pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return.  The settlement resolved allegations that the woman, Kelly Wolfe, participated in a scheme to defraud Medicare by filling sham prescriptions for Durable Medical Equipment (DME) like back, ankle, knee, and wrist...

Therakos Settlement Keeps Private Equity in DOJ’s Crosshairs for FCA Liability

Posted  12/4/20
durable medical equipment fraud whistleblower
On November 19th the United States Department of Justice (“DOJ”) announced an $11.5 million settlement involving the alleged promotion of two drug-device systems for unapproved uses by Therakos, Inc.  The action was initiated by a whistleblower under the qui tam provisions of the False Claims Act. The settling defendants included Johnson & Johnson subsidiary Medical Device Business Services, Inc. and The Gores...

Catch of the Week: 345 Charged in $6 Billion National Health Care Fraud and Opioid Takedown

Posted  10/2/20
Paper Ripped Uncovering Medical Necessity Wording
In the largest health care fraud and opioid enforcement action in the Justice Department’s history, 345 defendants—including more than 100 doctors, nurses, and other medical professionals—face charges for submitting over $6 billion in false or fraudulent claims to federal and private insurers.  Defendants stand accused of submitting $4.5 billion in fraudulent claims linked to telemedicine, $845 million...
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