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Constantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference

Posted  09/10/21
stethoscope on top of hundred dollars bills scattered around
Building on Constantine Cannon’s reputation as the preeminent law firm representing whistleblowers in FCA cases involving Medicare Advantage (MA) risk adjustment fraud, three Constantine Cannon attorneys, Mary Inman, Ed Baker, and Max Voldman, recently presented on case developments in this fast-developing area of the law at RISE West, a national conference for healthcare professionals working in the managed care...

Catch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme

Posted  09/3/21
telemedicine doctor on computer with patient
Editor’s Note: For this week’s biggest story, the record $90 million settlement secured by a Constantine Cannon client against Sutter Health, read more here.
Healthcare fraudsters have a track record of exploiting health crises for personal gain. The COVID-19 pandemic created new telemedicine opportunities for patients to receive care without having to see doctors in person. As expected, fraudsters seized on...

Managed Care Risk Adjustment Enforcement Continues with Sutter Health Settlement: Constantine Cannon Client Secures Largest Ever Medicare Advantage Settlement by a Hospital

Posted  08/30/21
Sutter Health will pay the Government $90 million under the False Claims Act for allegedly submitting inaccurate and unsupported medical information on tens of thousands of patients.  The settlement in a case brought by a whistleblower represented by Constantine Cannon, together with co-counsel Keller Grover and Kleiman Rajaram, is the largest Medicare Advantage FCA settlement against a hospital system, and the...

Private-Equity Red Flags Signal Potential False Claims Act Liability

Posted  05/21/21
person following a trail of money
Private equity (PE) firms that manage healthcare entities have further reason to take note of the growing record of exposure for False Claims Act (FCA) liability.

Martino-Fleming Case

In the latest shot across the bow, the PE firm, a majority shareholder of a for-profit mental-health provider, knew about the false claims and played a sufficiently active role in operations potentially to have caused them. Evidence...

P-Stim Fraud: A New DOJ Enforcement Priority?

Posted  04/23/21
The Department of Justice regularly publicizes its fraud prevention and False Claims Act enforcement priorities. These announced priorities typically focus on broad issues that affect the lives of millions of Americans – COVID-19 fraud, the opioid crisis, and the rapid expansion of telehealth.  In addition, we keep an eye on DOJ enforcement actions, and these can reveal emerging trends, often in narrow areas.  One...

Disturbing New Evidence Suggests Fraud Underlies Five-Star Ratings for Some Nursing Homes

Posted  03/19/21
Nurse helping elder man walking in rehab facility
Twelve years after the implementation of the nursing-home star-ratings system, a disturbing New York Times exposé and a lawsuit by California against Brookdale Senior Living reveals how the ratings are manipulated to the detriment of families in their time of crisis.  The NYT’s investigation and California’s allegations in combination paint the troubling picture of profits tied to higher star ratings, and...

Constantine Cannon and AARP Foundation Represent Advocacy Groups on behalf of Nursing-Home Patients to Ensure Facility Accountability

Posted  01/22/21
nurse checking elderly woman
Constantine Cannon LLP proudly joins the AARP Foundation in representing the National Consumer Voice for Quality Long-Term Care and California Advocates for Nursing Home Reform in a lawsuit seeking to roll back a directive undercutting accountability for nursing homes that violate federal standards.  The federal Nursing Home Reform Act of 1987 allows states to recommend to CMS that a non-compliant facility pay civil...

Top Ten State Healthcare and Financial Fraud Recoveries of 2020

Posted  01/8/21
person raising the U.S. flag
State and local governments are on the front lines of enforcing anti-fraud laws and play a critical role in ensuring that businesses and individuals are held accountable.  Whistleblowers with information about corporate misconduct involving healthcare, government procurement, financial regulation, and tax may find that state proceedings offer them the best option. More than 30 states have False Claims Acts that...

Top Ten Healthcare Fraud Recoveries of 2020

Posted  01/5/21
Healthcare Fraud
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

Constantine Cannon Settles Case Alleging Kickbacks to Multi-Practice Physicians’ Group for Referrals to Wholly Owned Ambulatory Surgery Center – Whistleblower Was Former CEO

Posted  10/9/20
doctor operating with nurse
Constantine Cannon, on behalf of whistleblower Jeffery Neuberger, has settled a False Claims Act action against Mid Dakota Clinic and a related entity.  Mr. Neuberger, the former CEO of the medical group, filed his case in 2017 alleging a scheme in violation of the Anti-Kickback Statute (AKS) between the medical group and its wholly owned ambulatory surgery center (ASC).  At issue was a financial arrangement whereby...
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