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U.S. Pursuit of Risk Adjustment Fraud Continues with Complaint in Intervention in Case Filed by Constantine Cannon Client against Independent Health and its Coding Subsidiary DxID

Posted  09/16/21
Western District of New York Birds-Eye View of Building
In July, we wrote that managed care enforcement had reached a “tipping point,” as the Department of Justice intervened in whistleblower cases against Kaiser Permanente alleging risk adjustment fraud, including a case brought by Constantine Cannon client Dr. James Taylor.  Just last month, we announced a $90 million settlement in a different Medicare Advantage risk adjustment fraud case brought by Constantine...

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...

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...

Media Coverage of Government Intervention in Kaiser Medicare Advantage Suits: LA Times says Cases Point to a “Massive Fraud Problem in Medicare”

Posted  08/6/21
Headshots of attorneys Edward Baker, Mary Inman, and Michael Ronickher
As we announced last week, the U.S. Department of Justice gave notice that it was intervening in six different False Claims Act lawsuits against Medicare Advantage organization Kaiser Permanente and its affiliated entities, including a whistleblower lawsuit filed by Constantine Cannon’s whistleblower client, James Taylor, M.D.  The government’s decision received extensive coverage in the media, with Los Angeles...

United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente

Posted  07/30/21
Kaiser Permanente Building with Logo
In a sign that the government’s enforcement efforts against fraud in the Medicare managed care system have reached a tipping point, the U.S. Department of Justice announced today that it is joining a portion of a whistleblower lawsuit brought by a Constantine Cannon client under the False Claims Act against Kaiser Permanente and affiliated entities, one of the nation’s largest managed-care organizations. ...

Constantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.

Posted  11/17/20
health insurance forms with stethoscope and calculator
Teresa Ross, a whistleblower represented by Constantine Cannon, and the Department of Justice have reached a settlement with Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative or GHC).  The Medicare Advantage Organization (MAO) has agreed to pay $6.375 million to resolve allegations that the insurance plan improperly collected money from the Medicare Advantage program by overstating how...

Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

Posted  08/28/20
department of justice website
Law360 recently interviewed former DOJ Civil Chief Jody Hunt on what he sees as the key issues surrounding False Claims Act enforcement these days.  Here are the top takeaways:
    • COVID-relief fraud will be a DOJ priority. No surprise there given the billions of dollars the federal government is pouring into the economy to alleviate some of the financial strain the pandemic is wreaking on healthcare providers...

Windfall to Health Insurers Due to COVID-19 Is Not Yet Resulting in Resolution of FCA Risk Adjustment Cases

Posted  08/21/20
As health insurers book record profits during the COVID-19 pandemic due to a dramatic decline in elective surgeries and procedures, this seems like a good time to ask about the status of False Claims Act litigation against Medicare Advantage Organizations (MAOs) relating to risk adjustment fraud.  Given the dire shortfall in state and federal money to fight the pandemic, when will MAOs begin paying back the billions...

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...

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...
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