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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...

Tagged in: FCA Federal, Financial and Investment Fraud, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Provider Fraud, SNF,

Catch of the Week: Unnecessary Blood Flow Tests Led to Unnecessary Flow of Healthcare Dollars

Posted 03/19/21

Doctor in handcuffs holding a stethoscope

Healthcare fraudsters routinely look for ways to extract money from federal health programs in ways that raise the least suspicion of their actions. One of these methods is through unnecessary diagnostic testing, which can often be lucrative when conducted routinely on large groups of patients. This week we focus on a recent settlement with Dr. Dinesh Shah and Michigan Physicians Group, P.C. (“MPG”) for $2...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Whistleblower Case,

The False Claims Act: It Benefits More than Just the Government

Posted 03/5/21

The False Claims Act, a Civil War-era law, encourages private individuals, such as whistleblowers, to come forward and file suit against unscrupulous government contractors, and share in the government's recovery. The passage of the law was inspired by contractors selling the Union Army bags of sand as flour, lame mules as cavalry horses, and glued-together rags as uniforms. The main purpose of the law is, of...

Tagged in: Dosage Fraud, Environmental Fraud, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Prevailing Wage,

DOJ Previews False Claims Act Enforcement Priorities for 2021

Posted 03/5/21

Department of Justice Seal on the United States Flag

The False Claims Act is the federal government's primary enforcement tool to combat fraud against the public. Every year the government recovers billions of dollars under the statute, primarily with the help of whistleblowers. Under the so-called qui tam provisions of the act, whistleblowers are authorized to act as private attorneys general and bring lawsuits on behalf of the government and recover a portion of...

Tagged in: COVID-19, Cybersecurity and Data Breaches, Electronic Health Records, FCA Federal, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Pharma Fraud, SNF,

Operation Brace Yourself Nets $20M Settlement with DME Fraudster

Posted 02/9/21

This week, the Department of Justice announced it had reached a $20.3 million settlement with a Florida businesswoman who pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return. The settlement resolved allegations that the woman, Kelly Wolfe, participated in a scheme to defraud Medicare by filling sham prescriptions for Durable Medical Equipment (DME) like back, ankle, knee, and wrist...

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Tax Fraud, Whistleblower Case,

Catch of the Week: Roche and Humana Agree to Settle Kickbacks in the Medicare Advantage Program

Posted 02/9/21

A recent settlement of a whistleblower case might be a sign of things to come for litigation under the False Claims Act (FCA) in the whistleblower program. Pharmaceutical company, Roche, and Medicare Advantage insurer, Humana, have agreed to pay $12.5 million to resolve allegations that the companies violated the anti-kickback statute. This is the first FCA settlement resulting out of a pharmaceutical company...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Managed Care, Medicare, Whistleblower Case,

Catch of the Week: EHR Vendor Athenahealth Settles Kickback Cases Brought by Whistleblowers

Posted 01/29/21

Computer screen showing electronic medical records system with ICD 10 codes

Athenahealth Inc. agreed to pay $18.25 million to resolve allegations that the electronic health records company violated the False Claims Act by paying unlawful kickbacks to potential customers and others. The government’s investigation was prompted by two whistleblower actions filed in 2017; the actions were consolidated and the government filed a complaint in intervention immediately prior to the...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Electronic Health Records, FCA Federal, Healthcare Fraud, Whistleblower Case,

Top Ten Financial and Healthcare Fraud Prison Sentences of 2020

Posted 01/27/21

Hands in handcuffs behind back of white man in business suit

Individuals involved in financial and healthcare fraud schemes face not just civil liability, but also criminal penalties – including prison time. In 2020, the Department of Justice obtained substantial prison sentences in a myriad of cases involving healthcare and financial frauds, many of which involved convictions of the type of fraudulent schemes that whistleblowers report. Whistleblowers play an essential role...

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Pharma Fraud, Ponzi Schemes, Top 10,

Top Ten Whistleblower Awards for 2020

Posted 01/22/21

2020 was another strong year for whistleblowers, who once again collectively recovered billions of dollars for the government and hundreds of millions of dollars in whistleblower rewards through their filing of lawsuits under the qui tam provisions of the False Claims Act. Whistleblowers this past year also continued to secure financial rewards under the Dodd-Frank SEC Whistleblower and CFTC Whistleblower programs,...

Tagged in: Anti-Kickback and Stark, Bribery and Bid-Rigging, CFTC Whistleblower Reward Program, FCA State, SEC Whistleblower Reward Program, Securities Fraud, Top 10, Whistleblower Case, Whistleblower Rewards,

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

Posted 01/22/21

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...

Tagged in: CC Lawyers, COVID-19, FCA Federal, Healthcare Fraud, Provider Fraud, SNF,

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

Catch of the Week: Unnecessary Blood Flow Tests Led to Unnecessary Flow of Healthcare Dollars

The False Claims Act: It Benefits More than Just the Government

DOJ Previews False Claims Act Enforcement Priorities for 2021

Operation Brace Yourself Nets $20M Settlement with DME Fraudster

Catch of the Week: Roche and Humana Agree to Settle Kickbacks in the Medicare Advantage Program

Catch of the Week: EHR Vendor Athenahealth Settles Kickback Cases Brought by Whistleblowers

Top Ten Financial and Healthcare Fraud Prison Sentences of 2020

Top Ten Whistleblower Awards for 2020

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

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