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Top Ten False Claims Act Recoveries in 2023

Posted 01/11/24

It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

Private Equity Firms Buying Healthcare Companies May Increase Risks to Patients and Lead to More Whistleblower Actions

Posted 01/8/24

Businessman Under Dark Shadow Pointing Finger

Private equity (PE) firms are in the hot seat, particularly when it comes to acquiring and investing in healthcare companies. According to a recent CNN article, a research study published in JAMA found that “[h]ealth care became more hazardous for patients at hospitals purchased by private equity firms.” This not only should concern patients and Government enforcers. It also could be a harbinger of more...

Tagged in: Healthcare Antitrust, Healthcare Fraud, Whistleblower Eligibility,

Catch of the Week: Moffitt Cancer Center

Posted 01/5/24

This week's Department of Justice (DOJ) Catch of the Week goes to Tampa-based H. Lee Moffitt Cancer Center & Research Institute Hospital. Yesterday (January 4), the non-profit cancer treatment and research center agreed to pay roughly $19.6 million to settle DOJ charges of violating the False Claims Act by billing Medicare for patient care services provided during research studies not eligible for...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Facility, Medical Billing Fraud, Medicare,

Community Health Network Pays $345 Million to Settle Stark Law Case

Posted 12/21/23

Handshake in room with dark window blinds

Community Health Network Inc., based in Indianapolis, recently settled with the U.S. government for $345 million, addressing allegations under the False Claims Act related to the Stark Law. This landmark case emphasizes the importance of whistleblowers to combat Medicare fraud. The Stark Law prevents hospitals from billing Medicare for services referred by physicians who have a financial relationship with the...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case,

Caught in the Crosshairs - Loyal Source Government Services

Posted 12/1/23

US Customs and Border Protection Flyer Behind US Flag

As reported in the Washington Post yesterday (November 30), a long-serving Customs and Border Protection (CBP) official filed a whistleblower complaint with Congress claiming significant failures by medical service contractor Loyal Source Government Services and CBP's refusal to address them. Even worse, when the whistleblower -- 14-year CBP veteran Troy Hendrickson -- tried to raise his concerns with his CBP...

Tagged in: Healthcare Fraud, Retaliation, Whistleblower Case,

OIG Identifies Fraud as Top Challenge in 2023 HHS Annual Report - Bring on the Whistleblowers

Posted 11/21/23

Person with Magnifying Glass and Pen Examining Stack of Papers

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) just released its 2023 Annual Report on its Top Management and Performance Challenges for the past year. Among the key challenges OIG identified is better protecting HHS programs -- Medicare and Medicaid being chief among them -- from fraud, waste, and abuse. No big surprise as this is a perennial challenge for the federal...

Tagged in: Healthcare Fraud, Medicaid, Medicare,

Caught in the Crosshairs - Department of Veteran Affairs

Posted 11/17/23

As reported this week in Military Times, a group of whistleblowers have complained of significant failings in the Department of Veteran Affairs (VA) suicide prevention hotline. According to the article, the Veterans Crisis Line has rapidly expanded in recent years, growing from roughly 900 employees in 2021 to more than 1,800 employees today. At the same time, however, there has been an equally dramatic rise in...

Tagged in: Other Government Health Programs,

$45.6 Million Settlement in False Claims Act Case Against Nursing Facility Defendants

Posted 11/17/23

Nurse Holding Clipboard in Front of Nursing Patient

The DOJ recently announced another settlement of a False Claims Act case against skilled nursing facilities (SNFs). This time, it was a $45.6 million settlement of a False Claims Act case that the government brought against six SNFs; a management company called Paksn Inc.; and Prema Thekkek, the owner. The six SNFs do business as (i) Bay Point Healthcare Center (Kayal Inc.); (ii) Gateway Care & Rehabilitation...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, SNF, Whistleblower Case,

DOJ Issues Elder Justice Report To Congress

Posted 10/26/23

A key focus of the Justice Department is prosecuting and deterring elder fraud and abuse. In the words of Attorney General Merrick Garland, “Every year, millions of older adults experience some form of elder abuse, neglect, financial exploitation, or fraud. … Holding to account those individuals and organizations that engage in elder fraud or abuse is the cornerstone of the Department’s elder justice...

Tagged in: FCA Federal, Healthcare Fraud,

Genetic Testing Scheme Leads to Another Fraud Conviction

Posted 10/11/23

The DOJ recently announced another fraud conviction in connection with genetic testing. This conviction from a federal jury in Florida is the latest word in a string of fraud actions against companies and individuals offering to provide genetic testing services. According to the DOJ, Jose Goyos and others managed the “‘doctor chase’ division” of a call center, which “contacted the primary care physicians...

Tagged in: Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Provider Fraud,

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Top Ten False Claims Act Recoveries in 2023

Private Equity Firms Buying Healthcare Companies May Increase Risks to Patients and Lead to More Whistleblower Actions

Catch of the Week: Moffitt Cancer Center

Community Health Network Pays $345 Million to Settle Stark Law Case

Caught in the Crosshairs - Loyal Source Government Services

OIG Identifies Fraud as Top Challenge in 2023 HHS Annual Report - Bring on the Whistleblowers

Caught in the Crosshairs - Department of Veteran Affairs

$45.6 Million Settlement in False Claims Act Case Against Nursing Facility Defendants

DOJ Issues Elder Justice Report To Congress

Genetic Testing Scheme Leads to Another Fraud Conviction

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