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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,

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

Posted 08/24/22

Doctor with stethoscope on computer screen

Prior to the pandemic, telehealth was basically nonexistent, with one study clocking the percentage of “virtual” doctors’ visits before Covid-19 at zero percent. At the time, America’s largest insurer, Medicare, only covered telemedicine in limited circumstances that usually still involved a visit to a healthcare facility. Medicare’s coverage limitations demonstrated the Department of Health and Human...

Tagged in: COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Provider Fraud,

DOJ Ramps Up Enforcement Against COVID-19 Fraud

Posted 04/25/22

Even as mask restrictions are being relaxed in most parts of the country, the U.S. Department of Justice is ramping up its oversight of federal funds spent to fight the COVID-19 pandemic. Just last week, DOJ announced criminal charges against 21 defendants in nine federal districts for their alleged participation in COVID-19 fraud schemes that resulted in over $149 million in false billings to federal programs.

Tagged in: COVID-19, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud,

Catch of the Week: Feds Shut The Door on an Uncommon Fraud Scheme involving New York Indigent Care Pool

Posted 02/3/22

The Southern District of New York announced a $12.9 million settlement with healthcare provider The Door, which provided services to uninsured youth for which it received reimbursement from New York State’s Indigent Care Pool. The settlement demonstrates the importance of whistleblowers, including the two that brought this case and stand to share in up to 25% of what the government collected, in helping to shut...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medicaid, Provider Fraud,

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Posted 01/14/22

The U.S. Attorney this week announced the arrest of doctors, businesspeople, an attorney, a New York police officer, and several others in one of the largest no-fault automobile insurance fraud takedowns in history. The investigation leading to their arrest was conducted by the U.S. Attorney’s Office for the Southern District of New York, the FBI, and the Westchester County District Attorney’s Office. The...

Tagged in: Catch of the Week, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

Top Ten Healthcare Fraud Recoveries of 2021

Posted 01/11/22

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...

Tagged in: Anti-Kickback and Stark, Chiropractic, Criminal Proceedings, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Catch of the Week: Pharmacy Owner Convicted in $174 Million Telehealth Fraud That Targeted Consumers and PBMs

Posted 12/10/21

In yet another example of how unscrupulous providers can take advantage of the benefits of telehealth (or telemedicine) to commit healthcare fraud, on December 2, 2021, a federal jury in Tennessee convicted Peter Bolos, the owner and operator of Synergy Pharmacy, located in Florida, of 22 criminal counts, including violating the Food, Drug and Cosmetic Act (FDCA) by introducing a misbranded drug into interstate...

Tagged in: Catch of the Week, Criminal Proceedings, Drug Switching, Healthcare Fraud, Medicaid, Pharma Fraud, Provider Fraud,

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

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medical Devices and DME, Pharma Fraud, Provider Fraud,

Catch of the Week: Classic Medicare Fraud

Posted 11/5/21

For those like your correspondents who spend their days deep in the weeds of complex Medicare fraud, it’s a delight when something refreshingly simple comes along. Thanks to Billy Joe Taylor of Arkansas, we can relax this Friday with a cool glass of straightforward Medicare fraud. For allegedly making $100 million in claims to CMS for tests that were not ordered or ever performed, he is our Catch of the...

Tagged in: Catch of the Week, COVID-19, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud,

Three States Impose Profit Limits on Nursing Homes

Posted 10/29/21

New York, New Jersey, and Massachusetts have just sent a clear message to nursing home operators: patient care must be prioritized over profits. Each state is introducing rules requiring nursing homes to spend a specific portion of their total revenue on direct patient care. In New York, it will be at least 70%, in Massachusetts at least 75%, and in New Jersey at least 90%. The three states are also limiting...

Tagged in: COVID-19, Healthcare Fraud, Provider Fraud, SNF,

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