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Page 14 of 17

HHS-OIG Continues to Uncover Unfounded Malnutrition Claims in Medicare Data

Posted  01/25/17
By the C|C Whistleblower Lawyer Team Inaccurate medical coding of malnutrition in seniors is a multi-billion dollar problem for Medicare, the federal health insurance program that primarily provides coverage to people aged 65 and older. As obscure as it sounds, it’s also an issue for the average American taxpayer, whose tax dollars are wrongly paid out to hospitals clever—or careless—enough to falsely claim...

The Importance of Medical Loss Ratio Minimum Requirements

Posted  01/24/17
By the C|C Whistleblower Lawyer Team We’ve covered Medical Loss Ratio (MLR) minimum requirements before. The MLR is, generally, the percentage of premium revenues an insurer spends on clinical services and quality improvements as opposed to on things like executive salaries, overhead, or marketing. Requiring a minimum MLR standard, something that the Federal Medicare Program does and several State Medicaid...

Fraudster Of The Week -- Dr. Aria Sabat

Posted  01/13/17
By the C|C Whistleblower Lawyer Team On Monday, a federal judge in the Eastern District of Michigan sentenced Dr. Aria Sabat to nearly 20 years in prison for defrauding Medicare and Medicaid and harming his patients.   Dr. Sabat pleaded guilty in May 2015 to various counts of fraud, one count of conspiracy to commit fraud leading to serious bodily injury, and one count of illegally distributing a controlled...

Texas Pediatric Dental Practices to Pay $8.45M to Settle False Claims Act Charges

Posted  01/10/17
By the C|C Whistleblower Lawyer Team Texas-based MB2 Dental Solutions and 21 of the company's affiliated pediatric dental practices agreed to pay $8.45 million to resolve allegations they violated the False Claims Act by submitting claims for pediatric dental services that were not rendered, were tainted by kickbacks, or based on misrepresentations of who performed the service. See DOJ Press Release. According...

Top-10 False Claims Act Kickback Recoveries For 2016

Posted  01/4/17
By the C|C Whistleblower Lawyer Team Here is our look-back at the top-10 Department of Justice False Claims Act recoveries in 2016 for violations of the Anti-Kickback Statute and/or the Stark Law.  Click here for a full chronological listing of all the DOJ False Claims Act recoveries in 2016.
  1. Lexington Medical Center -- The South Carolina hospital agreed to pay $17 million to resolve allegations it violated...

Top-10 DOJ False Claims Act Recoveries For 2016

Posted  01/3/17
By the C|C Whistleblower Lawyer Team Here is our look-back at the top-10 Department of Justice False Claims Act recoveries for 2016. 10. Vibra Healthcare -- The Pennsylvania-based hospital chain agreed to pay $32.7 million to resolve claims it violated the False Claims Act by billing Medicare for medically unnecessary services by admitting patients to its long term care hospitals and rehab facilities who did not...

Top-10 Whistleblower Successes for 2016

Posted  01/3/17
By the C|C Whistleblower Lawyer Team Here is our look-back at the top-10 whistleblower award recoveries for 2016. 10. Harry Markopolos -- Famed Bernie Madoff whistleblower Harry Markopolos made a filing under the whistleblower provisions of the Financial Institutions Reform, Recovery and Enforcement Act (FIRREA) which led to the agreement by Massachusetts-based State Street Bank and Trust Company to pay a total...

Medical Loss Ratio Minimum Requirements Save Taxpayer Dollars

Posted  12/14/16
By the C|C Whistleblower Lawyer Team Last month the Department of Health and Human Services’ Office of the Inspector General (OIG) published a report about the Medicaid Managed Care program and the potential savings related to a minimum medical loss ratio (MLR). An MLR is, generally, the percentage of premium revenues an insurer spends on clinical services and quality improvements as opposed to on things like...

DOJ Catch of the Week -- Life Care Centers of America Inc.

Posted  10/28/16
By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Life Care Centers of America Inc.  On Monday, the Tennessee-based operator of more than 220 skilled nursing facilities, and its owner Forrest L. Preston, agreed to pay $145 million to resolve charges that Life Care violated the False Claims Act by submitting claims to Medicare and TRICARE for rehabilitation therapy...

DOJ Catch of The Week -- Vibra Healthcare

Posted  09/30/16
By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Pennsylvania-based hospital chain Vibra Healthcare LLC.  On Wednesday, the company agreed to pay $32.7 million to settle charges it violated the False Claims Act by billing Medicare for medically unnecessary services.  Vibra operates roughly three-dozen long term care hospitals and inpatient rehabilitation...
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