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DOJ Catch of the Week - St. Joseph's Hospital Health Center

Posted 08/5/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to St. Joseph’s Hospital Health Center. On Monday, the Central New York hospital agreed to pay $3.2 million to resolve allegations it violated the federal False Claims Act and New York False Claims Act by billing the state Medicaid program for mental health services provided by unqualified staff. See DOJ Press...

Tagged in: Catch of the Week, FCA Federal, FCA State, Hospital Fraud, Improper Medical Personnel,

DOJ Catch of the Week -- Prime Healthcare

Posted 05/27/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Prime Healthcare Services. On Wednesday, the Justice Department announced its decision to intervene in a whistleblower lawsuit filed under the False Claims Act against Prime, its founder and CEO Dr. Prem Reddy, and 14 Prime hospitals in California. The government alleges that at Dr. Reddy's direction, these...

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

DOJ Catch of the Week -- 21st Century Oncology

Posted 03/11/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to 21st Century Oncology Inc., the nation’s largest physician led integrated cancer care provider. On Tuesday, the Florida-based company and its wholly owned subsidiary South Florida Radiation Oncology agreed to pay $34.7 million to settle charges they violated the False Claims Act by performing and billing for...

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

In Their Own Words — Rodriguez

Posted 02/25/16

-- “PUBLIC HEALTH INSURANCE PROGRAMS, LIKE MEDICARE, ARE NOT A PERSONAL POCKETBOOK FOR CRIMINALS SEEKING TO EXPLOIT A PROGRAM DESIGNED TO HELP.”

Diego Rodriguez, the FBI’s assistant director-in-charge, commenting on a $4 million Medicare fraud scheme involving unlicensed massage therapists. Read the DOJ press release here.

Tagged in: Improper Medical Personnel, In Their Own Words,

DOJ Catch Of The Week -- Kindred Healthcare

Posted 01/15/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Kentucky-based healthcare provider Kindred Healthcare, Inc. On Tuesday, the company and its two RehabCare Group subsidiaries agreed to pay $125 million to resolve allegations of violating the False Claims Act by knowingly causing skilled nursing facilities to submit false claims to Medicare for rehabilitation...

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

DOJ Catch Of The Week -- Nashville Pharmacy Services

Posted 01/8/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Nashville Pharmacy Services, LLC, and its majority owner Kevin Hartman. On Tuesday, Mr. Hartman and his Nashville-based pharmacy that specializes in dispensing HIV and AIDS-related medications agreed to pay up to $7.8 million to settle charges they overbilled Medicare and TennCare for pharmacy services. Click here...

Tagged in: Catch of the Week, Drug and DME Pricing, FCA Federal, FCA State, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

DOJ Catch Of The Week -- Pharmasan Labs

Posted 12/4/15

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Wisconsin-based Pharmasan Labs, Inc. and its related billing company NeuroScience, Inc. On Tuesday, both companies and their founders, Gottfried and Mieke Kellermann, agreed to pay $8.5 million to resolve charges they violated the False Claims Act by (i) submitting false information for laboratory services, and (ii)...

Tagged in: Catch of the Week, Improper Medical Personnel, Laboratory and IDTF, Whistleblower Case,

Medicare Advantage Plan Loses Members, Responds with Plans to Raise Risk Adjustment Scores

Posted 09/22/15

By Tim McCormack and Molly Knobler (published on The Compliance & Ethics Blog) Modern Healthcare recently reported that although enrollment in the Medicare Managed Care Program (also known as Medicare Advantage or Medicare Part C) has grown by 8% on average since 2010, several top Medicare Advantage Plans are losing membership. Highmark, Blue Cross and Blue Shield of North Carolina, HealthNow New York, Wellcare...

Tagged in: Healthcare Fraud, Managed Care, Medicare, Upcoding,

Stark Law Enforcement Trend: Hospital and Individual Physician Settle Allegations of Stark Law Violations and Illegal Upcoding

Posted 09/18/15

By Tim McCormack and Molly Knobler (published on SCCE’s Compliance and Ethics Blog) The Department of Justice’s (“DOJ”) recent string of victories against hospitals that have (allegedly) paid illegal inducements to employed physicians continues. On September 4, 2015, DOJ settled two False Claims Act (“FCA”) suits with Columbus Regional Healthcare System (“Columbus”) and Dr. Andrew Pippas. ...

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Provider Fraud, Upcoding,

Constantine Cannon And Department of Justice Continue Joint Pursuit Against California Sleep-Clinic Chain

Posted 09/4/15

By Jessica T. Moore Constantine Cannon LLP has filed an amended complaint on behalf of a whistleblower alleging multi-faceted fraud on the part of Bay Sleep Clinic and its owners and operators, and billing company Access Medical Consultants. The filing in United States ex rel. Dresser v. Qualium Corp., et al, Civil Action No. 12-1745 in the Northern District of California, comes on the same day the United...

Tagged in: Government Decision, Healthcare Fraud, Improper Medical Facility, Improper Medical Personnel, Laboratory and IDTF, Medicare, Whistleblower Case,

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DOJ Catch of the Week - St. Joseph's Hospital Health Center

DOJ Catch of the Week -- Prime Healthcare

DOJ Catch of the Week -- 21st Century Oncology

In Their Own Words — Rodriguez

-- “PUBLIC HEALTH INSURANCE PROGRAMS, LIKE MEDICARE, ARE NOT A PERSONAL POCKETBOOK FOR CRIMINALS SEEKING TO EXPLOIT A PROGRAM DESIGNED TO HELP.”

DOJ Catch Of The Week -- Kindred Healthcare

DOJ Catch Of The Week -- Nashville Pharmacy Services

DOJ Catch Of The Week -- Pharmasan Labs

Medicare Advantage Plan Loses Members, Responds with Plans to Raise Risk Adjustment Scores

Stark Law Enforcement Trend: Hospital and Individual Physician Settle Allegations of Stark Law Violations and Illegal Upcoding

Constantine Cannon And Department of Justice Continue Joint Pursuit Against California Sleep-Clinic Chain

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