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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...

Medicare Risk Adjustment Fraud is Not Victimless

Posted  06/18/20
medicare dollars
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...

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

Posted  05/15/20
doctor-on-phone
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...

Keeping Our Eyes Open for COVID-19 Fraud

Posted  05/1/20
coronavirus-map
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...

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

Posted  05/1/20
N95 Masks
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...

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...

Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Posted  04/2/20
Human Health Services Office of Inspector General Logo
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...

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...

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

Posted  03/6/20
Gavel close-up
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...

Treble Damages Awarded in Medicare Whistleblower Case

Posted  02/21/20
specimen jar
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...
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