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Home Health Agency Owner Pleads Guilty to Conspiring in $17 Million Medicaid Fraud Scheme

Posted 03/31/17

By the C|C Whistleblower Lawyer Team The owner and operator of five Houston-area home health agencies pleaded guilty to conspiring to defraud Medicare and the State of Texas’s Medicaid-funded Home and Community-Based Service and Primary Home Care programs of more than $17 million. He also pleaded guilty to conspiring to launder money. These health care programs provided qualified individuals with in-home...

Tagged in: Anti-Kickback and Stark, FCA State, Home Health and Hospice, Medicaid,

DOJ: Chicago Chiropractor Billed over $10 Million for Nonexistent Services

Posted 03/28/17

By the C|C Whistleblower Lawyer Team Seeking to crackdown on fraud within the chiropractic field, the Department of Justice recently announced the indictment of Chicago-based chiropractor Henry Posada on 18 counts of health care fraud. The government alleges that from 2008 to 2016, Posada fraudulently billed over $10 million in chiropractic services to both Medicare and private insurers. According to the...

Tagged in: Chiropractic, Medicaid, Medical Billing Fraud, Medicare,

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,

Sixteen charged in $60M Medicare hospice fraud scheme

Posted 03/1/17

By the C|C Whistleblower Lawyer Team The Department of Justice announced yesterday that a grand jury returned an indictment charging 16 Texas individuals with participating in a scheme to commit healthcare fraud, billing Medicare and Medicaid over $60 million for fraudulent hospice services, of which the government actually paid over $35 million. Defendants allegedly improperly placed patients in hospice and...

Tagged in: Home Health and Hospice, Medicaid, Medicare,

Nursing Home Operators Face Over $115M for Medicare Fraud

Posted 02/20/17

By the C|C Whistleblower Lawyer Team On February 15, a jury in the United States District Court for the Middle District of Florida found the operators of 53 skilled nursing facilities liable for over $115 million from false claims submitted to Medicare and Medicaid. The fraudulent claims involved a scheme where nursing facilities pretended patients needed and in turn received more care than they actually needed....

Tagged in: FCA Federal, Healthcare Fraud, Medicare, SNF,

United States Intervenes in Constantine Cannon Whistleblower’s suit against UnitedHealth Group, WellMed Medical Management

Posted 02/16/17

By the C|C Whistleblower Lawyer Team The U.S. Department of Justice has joined Constantine Cannon in bringing a whistleblower’s False Claims Act lawsuit against UnitedHealth Group, the nation’s largest health insurer and largest operator of Medicare managed healthcare insurance plans. The suit alleges UnitedHealth and its various subsidiaries and affiliates defrauded Medicare by improperly inflating its risk...

Tagged in: Government Decision, Managed Care, Medicare, Risk Adjustment Fraud, Upcoding, Whistleblower Case,

TeamHealth to Pay $60M to Settle Whistleblower Charges

Posted 02/7/17

By the C|C Whistleblower Lawyer Team U.S. hospital service provider TeamHealth Holdings agreed to pay $60 million to settle charges its predecessor company IPC Healthcare Inc. violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed. See DOJ Press...

Tagged in: FCA Federal, Medicaid, Medicare, Upcoding,

Kentucky Pain Management Physician Pays $20M to Settle FCA Charges

Posted 02/2/17

By the C|C Whistleblower Lawyer Team Dr. Robert Windsor, the owner of several Kentucky and Georgia pain management clinics operating under the umbrella of National Pain Care, Inc., agreed to a $20 million consent judgment resolving government allegations he billed federal health care programs for surgical monitoring services he did not perform, and for medically unnecessary diagnostic tests. To satisfy the...

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Other Government Health Programs,

Major Insulin Makers Accused of Price Fixing

Posted 01/31/17

By the C|C Whistleblower Lawyer Team As reported in the New York Times, a group of diabetes patients filed suit yesterday against the three dominant providers of insulin, alleging they systematically raised prices through a price-fixing scheme that imposed on patients “crushing out-of-pocket expenses.” The lawsuit -- brought against Sanofi, Novo Nordisk and Eli Lilly -- comes only a few months after Senator...

Tagged in: Medicare, Pharma Fraud,

Medicare Fraud Alert: Inpatient Rehabilitation Hospitals

Posted 01/26/17

By the C|C Whistleblower Lawyer Team A recently-released report from Department of Health and Human Services Office of the Inspector General (HHS-OIG) revealed potentially serious problems related to Medicare beneficiary stays in inpatient rehabilitation hospitals. Such hospitals—either standalone or included as distinct units within general-purpose hospitals—are designed to address the needs of patients who...

Tagged in: FCA Federal, Hospital Fraud, Medicare,

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Home Health Agency Owner Pleads Guilty to Conspiring in $17 Million Medicaid Fraud Scheme

DOJ: Chicago Chiropractor Billed over $10 Million for Nonexistent Services

DOJ intervenes in $50 Million Healthcare Fraud Case

Sixteen charged in $60M Medicare hospice fraud scheme

Nursing Home Operators Face Over $115M for Medicare Fraud

United States Intervenes in Constantine Cannon Whistleblower’s suit against UnitedHealth Group, WellMed Medical Management

TeamHealth to Pay $60M to Settle Whistleblower Charges

Kentucky Pain Management Physician Pays $20M to Settle FCA Charges

Major Insulin Makers Accused of Price Fixing

Medicare Fraud Alert: Inpatient Rehabilitation Hospitals

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