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Top Ten State Fraud Recoveries of 2022

Posted 01/19/23

State and local governments play a critical role in ensuring that businesses and individuals are held accountable if they commit healthcare fraud, financial fraud, government contract fraud, and more. For whistleblowers, state governments can offer additional opportunities to report wrongdoing. Where government funds are at stake – and state and local government spending reaching $3 trillion annually – more...

Tagged in: FCA State, Financial and Investment Fraud, Government Procurement Fraud, Healthcare Fraud, Housing and Mortgage Fraud, Medicaid, Money Laundering, Private Insurance Whistleblower Reward Programs, Top 10,

Top Ten Healthcare Fraud Recoveries of 2022

Posted 01/6/23

Healthcare fraud image showing stethoscope with gavel

Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

Catch of the Week: 18 Former N.B.A. Players Charged in Healthcare Fraud Scheme

Posted 10/8/21

Former professional basketball players, including Terence Williams, "Big Baby" Glen Davis, Sebastian Telfair, and Tony Allen, have been indicted for submitting fraudulent claims for reimbursement of medical and dental services not actually rendered. From 2017 through last year, defendants' scheme caused the N.B.A. Players' Health and Welfare Benefit Plan ("the Plan") to pay out nearly $4 million in false claims....

Tagged in: Catch of the Week, Criminal Proceedings, Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

Catch of the Week – Sour Grapes: Fruit-Broker Squashed for Role in Defrauding Federal Crop Insurance

Posted 08/13/21

The manager of a California fruit broker learned the hard way that it doesn’t pay to assist in defrauding the Federal Crop Insurance Program. The manager, at the behest of a grape farmer who sold crops through the broker, altered the farmer’s records to reflect lower-than-actual sales. The falsified records assisted the farmer to claim crop-losses falsely and receive insurance-reimbursements funded by the...

Tagged in: Catch of the Week, Crop Insurance, FCA Federal, FIRREA, Flood Insurance, Private Insurance Whistleblower Reward Programs,

New Settlement Shows the Power of Whistleblowers to Root out Fraud against Private Insurers

Posted 08/6/20

The nation’s biggest insurers, Medicare, Medicaid, and TRICARE already incentivize whistleblowers to report fraud. Because those programs are federally-funded, a whistleblower can bring suit under the False Claims Act and share in 15-30% of the recovery. The FCA is a law that allows private individuals alleging fraud against the government to bring a lawsuit in the name of the United States. The law leads to about...

Tagged in: FCA Federal, Importance of Whistleblowers, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Whistleblower Case, Whistleblower Eligibility, Whistleblower Rewards,

How to Be a Whistleblower

Posted 07/19/19

You know about fraud, waste, abuse, or corruption by an individual or a company. Someone is getting by with cheating -- taking money from the government, taxpayers, or investors, or even harming others, such as patients. You are deeply troubled about it and want the proper authorities to stop it. You are worried whether you will be heard, taken seriously, and protected. You wonder if your information fits within a...

Tagged in: Auto Safety, CFTC Whistleblower Reward Program, Employment Issues, FCA Federal, FCA State, Importance of Whistleblowers, Private Insurance Whistleblower Reward Programs, Retaliation, SEC Whistleblower Reward Program, Whistleblower Answers, Whistleblower Protection Laws, Whistleblower Rewards,

Healthcare Fraud also Harms Private Insurers - and Whistleblowers can Help

Posted 04/25/19

Health insurance forms, stethoscope, calculator and dollars

Whistleblowers with information about healthcare fraud look first to the False Claims Act, and the impact that healthcare fraud has on Medicare, Medicaid, and other government healthcare spending. But, healthcare fraud that harms private insurance companies – as opposed to government payors – also attracts government enforcement attention. Several recent criminal prosecutions in Texas and elsewhere...

Tagged in: Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

Healthcare Fraud: it’s not just Medicare and Medicaid

Posted 10/17/18

Last year, the U.S. Department of Justice recovered $2.4 billion in settlements and judgments involving fraud in the healthcare industry perpetrated against government payors. But government programs like Medicare and Medicaid aren’t the only targets of massive healthcare fraud schemes. A recent Department of Justice press release announced the unsealing of a 32-count indictment containing charges against four...

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

Fraudster of the Week -- Monarch Medical Group

Posted 04/28/17

Last week, California state prosecutors charged 26 individuals, including 21 physicians and 2 pharmacists, in connection with a kickback scheme orchestrated by Tanya and Christopher King, the owners of a practice management company called Monarch Medical Group and other related companies. If convicted, the involved physicians could face up to 25 years in prison and the pharmacists could face up to 28 years. ...

Tagged in: Catch of the Week, Compounding Pharmacy Fraud, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud,

DOJ intervenes in $50 Million Healthcare Fraud Case

Posted 03/2/17

By the C|C Whistleblower Lawyer Team Preet Bharara, US Attorney for the Southern District of New York, announced a civil suit and criminal actions against several doctors and health care entities alleging over $50M in fraud through schemes that lasted over 12 years. Five of the six doctors charged in their personal capacity were arrested in the New York area on Wednesday. The allegations center around Asim...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Decision, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Private Insurance Whistleblower Reward Programs, Provider Fraud,

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Top Ten State Fraud Recoveries of 2022

Top Ten Healthcare Fraud Recoveries of 2022

Catch of the Week: 18 Former N.B.A. Players Charged in Healthcare Fraud Scheme

Catch of the Week – Sour Grapes: Fruit-Broker Squashed for Role in Defrauding Federal Crop Insurance

New Settlement Shows the Power of Whistleblowers to Root out Fraud against Private Insurers

How to Be a Whistleblower

Healthcare Fraud also Harms Private Insurers - and Whistleblowers can Help

Healthcare Fraud: it’s not just Medicare and Medicaid

Fraudster of the Week -- Monarch Medical Group

DOJ intervenes in $50 Million Healthcare Fraud Case

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