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Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

Posted 08/28/20

Law360 recently interviewed former DOJ Civil Chief Jody Hunt on what he sees as the key issues surrounding False Claims Act enforcement these days. Here are the top takeaways:

- COVID-relief fraud will be a DOJ priority. No surprise there given the billions of dollars the federal government is pouring into the economy to alleviate some of the financial strain the pandemic is wreaking on healthcare providers...

Tagged in: Anti-Kickback and Stark, COVID-19, Electronic Health Records, FCA Federal, Government Loan Programs, Home Health and Hospice, Importance of Whistleblowers, Risk Adjustment Fraud, Whistleblower Eligibility,

OIG Audit Suggests Home Health Agencies Submit Unsupported Visits to Trigger Higher Medicare Reimbursement

Posted 07/31/20

visiting nurse with elder woman sitting on a couch

OIG released results from its targeted audit of certain home health care claims submitted for payment and found $191.8 million of overpayments in 2017 alone. OIG's objective was to determine whether payments for home health services with five to seven visits in a payment episode complied with Medicare requirements. During the 2017 audit period, under Medicare's home health prospective payment system, home health...

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

Press Round-Up: Settlement in Visiting Nurse Service of New York Case Described as Groundbreaking

Posted 07/2/20

The record-setting $57 million settlement in U.S. ex rel. Lacey v. Visiting Nurse Service of New York, a False Claims Act case brought by Constantine Cannon client Edward Lacey, received extensive coverage in the media, with stories noting that the wrongdoing alleged was “pervasive” in the home health industry. As a whistleblower, Lacey alleged that home health agency VNSNY failed to adhere to the plans of care...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medical Billing Fraud, Whistleblower Case,

Visiting Nurse Service of New York Settles Whistleblower Case Brought by Constantine Cannon Client for $57 Million

Posted 06/26/20

Constantine Cannon is pleased to announce a $57 million settlement of the False Claims Act lawsuit its whistleblower client brought against the Visiting Nurse Service of New York (VNSNY). VNSNY is the largest not-for-profit home health care agency in the country, serving roughly 150,000 patients a year in New York, most of whom are elderly and/or disabled. The whistleblower, Edward Lacey, was an executive at...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case,

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Posted 03/6/20

In a significant win for whistleblowers, a federal appellate court held this week that, in order to determine liability under the False Claims Act, a whistleblower need not prove that a claim is “objectively” false. Instead, the Court held that, consistent with common law, a claim can be false under the FCA if based not on objectively verifiable facts, but on non-compliance with statutory or regulatory...

Tagged in: Court Decision, FCA Federal, Home Health and Hospice, Importance of Whistleblowers, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Eligibility,

Catch of the Week: Guardian Elder Care

Posted 02/21/20

This week's DOJ Catch of the Week goes to Guardian Elder Care. On Wednesday, the operator of more than 50 nursing homes in Pennsylvania, Ohio and West Virginia agreed to pay roughly $15.5 million to resolve allegations it violated the False Claims Act by billing the government -- Medicare and the Federal Employees Health Benefits Program -- for medically unnecessary rehabilitation therapy services. According to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Improper Medical Facility, Improper Medical Personnel, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

Government Documents Dangerous Failures in Hospice-Care Facilities

Posted 07/19/19

The Department of Health and Human Services (HHS) recently released two deeply concerning reports about failures in hospice care. Hospices put patients in harm’s way by failing to meet Medicare’s standards of care, failing to protect patients from abuse, and failing to report dangerous conditions. All told, the reports paint a grim picture of substandard health services for a particularly vulnerable patient...

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

United States Intervenes in Home Health Care Fraud Case

Posted 05/30/19

Doctor Hand Taking Money from Patient's Hand

Last week, the United States intervened in a lawsuit brought against Florida-based Doctor’s Choice Home Care and its two owners. The Department of Justice alleged that the company bribed doctors to refer patients in violation of the federal Anti-Kickback Statute and Stark Law. Both laws prohibit medical providers from paying or receiving kickbacks in connection with government-funded health care...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Decision, Home Health and Hospice, Whistleblower Case, Whistleblower Eligibility,

Catch of the Week — Hospice Provider to Pay $6 Million to Settle False Claims Act Suit

Posted 12/21/18

Younger person resting hand on hand of seated elderly woman with cane

SouthernCare, Inc., a hospice provider owned by Curo Health Services, has agreed to pay the federal government nearly $6 million dollars to settle a lawsuit alleging that the company defrauded Medicare by billing medically unnecessary hospice care. The fraud was unearthed by two whistleblowers formerly employed by the company, who filed suit under the qui tam provisions of the False Claims Act, where they will share...

Tagged in: Catch of the Week, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case,

Catch of the Week -- Health Quest Systems and Putnam Hospital Center

Posted 07/13/18

This week, DOJ announced a $14.7 million settlement with NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid, making Health Quest and Putnam our Catch of the Week. The settlement resolves allegations stemming from three separate lawsuits bought by...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Home Health and Hospice, Hospital Fraud, Medicaid, Medical Billing Fraud, Medicare, Multiple Whistleblowers and First-to-File, Upcoding, Whistleblower Case, Whistleblower Rewards,

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Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

OIG Audit Suggests Home Health Agencies Submit Unsupported Visits to Trigger Higher Medicare Reimbursement

Press Round-Up: Settlement in Visiting Nurse Service of New York Case Described as Groundbreaking

Visiting Nurse Service of New York Settles Whistleblower Case Brought by Constantine Cannon Client for $57 Million

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Catch of the Week: Guardian Elder Care

Government Documents Dangerous Failures in Hospice-Care Facilities

United States Intervenes in Home Health Care Fraud Case

Catch of the Week — Hospice Provider to Pay $6 Million to Settle False Claims Act Suit

Catch of the Week -- Health Quest Systems and Putnam Hospital Center

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