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CATCH OF THE WEEK — Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M

Posted 10/11/19

Our latest Catch of the Week highlights the successful resolution of a whistleblower lawsuit against a Southern California eye doctor group and several individuals allegedly embroiled in a decade-long scheme to bill publicly funded healthcare programs for unnecessary eye exams. Ophthalmology provider group Retina Institute of California Medical Group (RIC), its former CEO, several of its doctors, and other involved...

Tagged in: FCA Federal, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

Catch of the Week — Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Posted 09/18/19

On Monday, a federal judge in Houston sentenced Starsky Bomer, the former CFO and COO of Atrium Medical Center and Pristine Healthcare, to ten years in prison for his role in a Medicare fraud scheme that bilked the government of $16m. Bomer was convicted by a jury in October of last year. His co-conspirator, Dr. Sohail R. Siddiqui, took a plea deal in 2017 and is serving five years in prison. Bomer will do time...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Eligibility,

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Posted 09/13/19

Philip Esformes, 50, of Miami Beach, Florida, was sentenced to 20 years in prison for his role in a decades-long billion-dollar scheme to submit fraudulent claims to Medicare and Medicaid both for services deemed medically unnecessary and services that were medically necessary but that he did not provide. Esformes personally pocketed $37 million from this scheme to fund his lavish lifestyle, while leaving elderly...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, SNF,

Medicare Whistleblowers: The Most Common Questions Answered About Reporting Medicare Fraud

Posted 09/10/19

What potential whistleblowers need to know about reporting fraud in government healthcare programs.

Get answers to 6 common Medicare whistleblower questions

In this article, our experienced whistleblower attorneys have answered 6 of the most important and common questions posed by individuals who have knowledge of potential healthcare fraud, specifically, fraud in the Medicare program. Click the links below to...

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

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...

Tagged in: FCA Federal, FCA State, Hospital Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, Public Disclosure and Public Information, Whistleblower Case, Whistleblower Eligibility,

DOJ Catch of the Week — Beaver Medical Group

Posted 08/9/19

Yesterday, California-based Beaver Medical Group and one of its physicians, Dr. Sherif Khalil, agreed to pay roughly $5 million to resolve allegations they violated the False Claims Act by reporting invalid diagnoses to Medicare Advantage plans causing those plans to receive inflated payments from Medicare. It is the latest example of what has become a strong government commitment to pursuing fraud in the Medicare...

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Posted 08/2/19

This week marks the seventh year in a row that Congress has designated July 30^th National Whistleblower Day, honoring the occasion, on July 30, 1778, when the Continental Congress unanimously enacted the first whistleblower protection law in the United States. The law was passed in response to a petition to the Continental Congress filed by a group of ten American sailors and marines, who reported that their...

Tagged in: Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, Whistleblower Eligibility, Whistleblower Rewards,

Government Documents Dangerous Failures in Hospice-Care Facilities

Posted 07/19/19

The Department of Health and Human Services (HHS) recently released two deeply concerning reports about failures in hospice care. Hospices put patients in harm’s way by failing to meet Medicare’s standards of care, failing to protect patients from abuse, and failing to report dangerous conditions. All told, the reports paint a grim picture of substandard health services for a particularly vulnerable patient...

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted 07/12/19

Pill container spilled over with pills fallen out.

On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

Tagged in: Anti-Kickback and Stark, FDA Fraud, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Provider Fraud,

Question of the Week — Should providers who defraud Medicare be excluded from it?

Posted 06/18/19

Fortune Cookie with Message with Message Saying "Not Eligible for Medicare!"

Sometimes, though rarely, when a medical provider settles a False Claims Act case or is found to have violated the FCA at trial, they are excluded from participating in healthcare programs as a condition of resolving the case. Often, this is a limited-time ban that is meant to incentivize providers to follow Medicare’s rules in the future and to deter other providers from committing fraud. Between Medicare,...

Tagged in: FCA Federal, Medical Billing Fraud, Medicare, Question of the Week, Upcoding,

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CATCH OF THE WEEK — Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M

Catch of the Week — Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Medicare Whistleblowers: The Most Common Questions Answered About Reporting Medicare Fraud

Get answers to 6 common Medicare whistleblower questions

Is Data the Future of Whistleblowing?

DOJ Catch of the Week — Beaver Medical Group

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Government Documents Dangerous Failures in Hospice-Care Facilities

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Question of the Week — Should providers who defraud Medicare be excluded from it?

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