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Regeneron: The Government’s Latest Stand against Patient Kickbacks

Posted 06/25/20

pills, syringes, and money scattered around

This week, Boston-based prosecutors have filed a new False Claims Act case against Regeneron, a pharmaceutical company, alleging that it paid patients kickbacks aiming to steer them into using Regeneron’s macular degeneration drug, Eylea. Regeneron allegedly disguised the kickbacks as charitable contributions to a foundation. Prosecutors say that Regeneron only donated exactly enough money to the foundation, called...

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Medicare, Pharma Fraud,

Medicare Risk Adjustment Fraud is Not Victimless

Posted 06/18/20

Implicit in the arguments made by many Medicare Advantage Organizations (MAOs), health plans, hospital networks and other defendants in response to whistleblower and government False Claims Act complaints is that the alleged misconduct—falsifying diagnosis data so that CMS overpays for patients enrolled in an MA plan—involves just a technical record-keeping or administrative dispute with CMS and no actual...

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Risk Adjustment Fraud,

Telehealth Expansion is Here to Stay, We Must Be Wary of Fraud

Posted 05/15/20

Telemedicine, or the provision of medical services through virtual means, has been rapidly expanding for the past several years. In 2010, barely a third of hospitals were offering telehealth services; by 2017, over three-quarters of hospitals were doing so. Telemedicine has a lot of potential for good. It’s becoming increasingly accessible and affordable thanks to technological advancements. Innovations such...

Tagged in: COVID-19, Government Programs Fraud, Healthcare Fraud, Medicare,

Keeping Our Eyes Open for COVID-19 Fraud

Posted 05/1/20

The COVID-19 pandemic is shaping the way we live around the world and dominating headlines. Inevitably, it will be a major focus for government enforcement agencies. The whistleblower team at Constantine Cannon is closely tracking reports of fraud in the Coronavirus response. This week, we launched a new webpage as a hub for COVID-19 fraud news. We encourage you to visit this page, which will be updated...

Tagged in: COVID-19, Financial and Investment Fraud, Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, Whistleblower Rewards,

COVID Frauds of the Week: Misrepresented Mask Inventories and Medicare Fraud

Posted 05/1/20

Amid COVID-19-induced fear and hardship, fraud is on the rise. Already, the FTC has received over 18,000 reports of COVID-19 related fraud. In response, the SEC, CFTC, and other regulators announced they are on the lookout for pandemic-related fraud, and the DOJ warned would-be wrongdoers that it will not tolerate profiting off of public panic. This week, we focus on three enforcement actions brought by the...

Tagged in: Catch of the Week, COVID-19, Healthcare Fraud, Medicare, SEC Whistleblower Reward Program, Securities Fraud,

New Lawsuit Against Anthem Shows the Government’s Commitment to Medicare Advantage Fraud

Posted 04/3/20

health insurance with stethoscope and hundred dollar bills

Medicare Advantage, also called Medicare Part C, is ever-expanding part of our healthcare system. The program now insures over a third of total Medicare beneficiaries, well over 10 million people. An expansion in fraud has accompanied the program’s expansion, and the Department of Justice is zeroing in, with the Assistant Attorney General for the Civil Division, Joseph Hunt, recently declaring it a...

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Risk Adjustment Fraud,

Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Posted 04/2/20

The HHS OIG recently released the Medicaid Fraud Control Units (MFCUs) Fiscal Year 2019 Annual Report, providing a consolidated accounting of the program’s success. MFCUs investigate and prosecute Medicaid fraud and patient abuse or neglect. MFCUs receive referrals from other agencies, the public, or via data mining with OIG approval. The referral is reviewed, an investigation is conducted, and the decision is...

Tagged in: Criminal Proceedings, Government Programs Fraud, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

Medicaid Drug Rebate Fraud: Should it be an Enforcement Priority?

Posted 03/10/20

pill container spilled over with pills in the form of a dollar sign

Medicaid has one very intuitive approach to keeping drug prices in check. Drug companies, under a law called the Medicaid Drug Rebate Program, must rebate Medicaid programs any money that resulted from the increased drug prices outpacing inflation. Inflation is benchmarked to either 1990, or the first year a drug came to market, which ever is later. As an example of how this works, imagine a pharmaceutical company...

Tagged in: Drug and DME Pricing, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicaid, Pharma Fraud, Whistleblower Rewards,

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Posted 03/6/20

In a significant win for whistleblowers, a federal appellate court held this week that, in order to determine liability under the False Claims Act, a whistleblower need not prove that a claim is “objectively” false. Instead, the Court held that, consistent with common law, a claim can be false under the FCA if based not on objectively verifiable facts, but on non-compliance with statutory or regulatory...

Tagged in: Court Decision, FCA Federal, Home Health and Hospice, Importance of Whistleblowers, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Eligibility,

Treble Damages Awarded in Medicare Whistleblower Case

Posted 02/21/20

The Fifth Circuit upheld a 2018 lower court decision this week, finding defendant BestCare Laboratory Services, LLC and its owner Karim Maghareh liable for treble damages—to the tune of just over $30 million—under the False Claims Act. BestCare provided clinical testing services for nursing home residents, many of whom were Medicare beneficiaries. Rather than billing for a technician’s travel to and from the...

Tagged in: Court Decision, Defenses, FCA Federal, Importance of Whistleblowers, Laboratory and IDTF, Medical Billing Fraud, Medicare, Whistleblower Case,

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Regeneron: The Government’s Latest Stand against Patient Kickbacks

Medicare Risk Adjustment Fraud is Not Victimless

Telehealth Expansion is Here to Stay, We Must Be Wary of Fraud

Keeping Our Eyes Open for COVID-19 Fraud

COVID Frauds of the Week: Misrepresented Mask Inventories and Medicare Fraud

New Lawsuit Against Anthem Shows the Government’s Commitment to Medicare Advantage Fraud

Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Medicaid Drug Rebate Fraud: Should it be an Enforcement Priority?

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Treble Damages Awarded in Medicare Whistleblower Case

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