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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...

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...

Congress Highlights Medicare Part D Plans’ Failure To Prevent Fraud

Posted  07/16/15
Fraud in the Medicare Part D prescription drug program is getting the attention of not only the Department of Health and Human Services’ Office of the Inspector General (HHS OIG) but also watchdogs on Capitol Hill.  On Tuesday, July 14, 2015, the House of Representatives’ Committee on Energy and Commerce held a hearing to examine two recent reports from HHS OIG examining improper spending in the Medicare Part...

DOJ Gives Major Shoutout To Whistleblowers In $450M DaVita False Claims Act Settlement

Posted  06/26/15
By Gordon Schnell On Wednesday, Denver-based provider of dialysis services DaVita Healthcare Partners, Inc. agreed to pay $450 million to resolve charges it violated the False Claims Act by purposely creating and then billing the government for unnecessary waste in administering the drugs Zemplar and Venofer to dialysis patients.  DaVita is the largest provider of dialysis services in the US with dialysis clinics...

Whistleblower Spotlight -- Deceased VA Whistleblower Christopher Kirkpatrick

Posted  04/23/15
By the C|C Whistleblower Lawyer Team This week's "Whistleblower Spotlight" features Christopher Kirkpatrick, the 38-year old clinical psychologist who took his own life after being fired from the Tomah Veterans Affairs Medical Center for complaining about the treatment of his patients there.  Kirkpatrick would appear to be just one of the scores of whistleblowers who have been retaliated against for stepping up to...

DOJ Catch Of The Week — Medtronic

Posted  04/3/15
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to medical device maker Medtronic plc and affiliated Medtronic companies, Medtronic Inc., Medtronic USA Inc., and Medtronic Sofamor Danek USA Inc.  Yesterday, the companies agreed to pay $4.4 million to resolve allegations they violated the False Claims Act by making false statements to the Department of Veterans...

DOJ Catch of the Week -- Community Health Systems

Posted  08/8/14
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to Community Health Systems, Inc.  On Monday, the Tennessee-based operator of acute care hospitals -- the largest in the country with 206 affiliated hospitals in 29 states -- agreed to pay $98 million to resolve charges of billing the government for inpatient services that should have been billed as significantly less...

DOJ Catch of the Week – Vascular Solutions

Posted  08/1/14
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to Vascular Solutions Inc (VSI).  On Monday, the Minneapolis-based medical device maker agreed to pay $520,000 to resolve allegations that it violated the False Claims Act by marketing a product for sealing veins without FDA approval.  Specifically, the government charged that VSI marketed and sold its "Vari-Lase...

More Trouble for Orthofix

Posted  12/20/12
By Marlene Koury Medical device maker Orthofix, Inc. this week obtained court approval for its June 2012 settlement proposal to resolve civil and criminal allegations that it defrauded Medicare through kickback schemes and overbilling for its bone-growth stimulators.  Click here for the original government press release.  The company will pay approximately $43 million for its misdeeds.  This payment follows on...

Blackstone Medical Caught “Entertaining” Physicians in Exchange for Business

Posted  11/13/12
By Marlene Koury Orthofix International NV has agreed to pay $30 million to settle allegations that its subsidiary, Blackstone Medical Inc., ran a seven year long kickback scheme ranging from sham consulting agreements to providing physicians with adult “entertainment” to induce them into ordering their products.  Click here to see Department of Justice press release and here for the complaint. Blackstone...
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