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Data Whistleblower Case Raises Question of What is a Public Disclosure

Posted  02/21/19
Rows of chairs with people waiting in hospital billing office
As regular readers know, we have been closely tracking the progress of data analysis firm Integra Med Analytics’ whistleblower lawsuit under the False Claims Act against Providence Health and its consultant J.A. Thomas and Associates, Inc. (JATA).  The case alleges a conspiracy between Providence and JATA to upcode for specific Major Complications or Comorbidities (MCCs). This case is part of a growing number of...

Tagged in: Court Decision, FCA Federal, Healthcare Fraud, Hospital Fraud, Public Disclosure and Public Information, Upcoding, Whistleblower Case,

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Top Ten Healthcare Recoveries of 2018

Posted  01/15/19
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2018 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Here are the top ten healthcare recoveries of 2018 by the numbers:
    1. Amerisource Bergen Corporation - In...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Managed Care, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Risk Adjustment Fraud, Top 10,

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Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

Posted  12/14/18
Doctor discussing knee injury with patient seated on exam table
Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act for submitting false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health is a for-profit hospital and health system based in the Lehigh...

Tagged in: Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

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Catch of the Week — Health Management Associates

Posted  09/27/18
Health Management Associates, LLC (“HMA”), a former hospital chain now part of Community Health Systems, agreed on September 25th to a $260 million settlement to resolve allegations of false billing and kickbacks alleged in eight qui tam cases under the False Claims Act (“FCA”). HMA was a hospital chain headquartered in Tampa, Florida that was acquired by Community Health Systems Inc., a major U.S. hospital...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

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Inman writes on whistleblower case brought by outsider

Posted  08/30/18
Constantine Cannon partner Mary Inman published an article in RAC Monitor about a lawsuit brought against Providence Health & Services and its consultant J.A. Thomas and Associates LLC (JATA) by Integra Med Analytics LLC, a data analysis firm that uses statistical analysis of publicly available data to attempt to uncover and prove fraud. Integra alleged that it analyzed seven years’ worth of publicly-available...

Tagged in: FCA Federal, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Eligibility,

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Catch of the Week -- Prime Healthcare

Posted  08/9/18
upcoding
Prime Healthcare, a nationwide healthcare provider that operates 45 hospitals and employs over 40,000 people, has settled allegations under the False Claims Act that 14 of its California hospitals improperly billed Medicare for admitting patients who only required outpatient care, and billed Medicare for treating more severe diagnoses than patients actually had. The company will pay just under $62 million to settle...

Tagged in: Catch of the Week, Damages and Penalties, Defendants, FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

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Catch of the Week -- William Beaumont Hospital

Posted  08/3/18
This week’s Department of Justice “Catch of the Week” goes to William Beaumont Hospital, a regional hospital system based in the Detroit area. On Thursday, the company agreed to pay $84.5 million to resolve allegations under the False Claims Act of improper relationships with eight referring physicians, resulting in the submission of false claims to the Medicare, Medicaid and TRICARE programs. The settlement...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

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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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Banner Health Agrees to Pay $18 Million to Settle Whistleblower Case

Posted  04/13/18
By the C|C Whistleblower Lawyer Team Banner Health has agreed to pay over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis.  Headquartered in Arizona, Banner Health owns and operates 28 acute-care hospitals in multiple states. “Taxpayers should not bear...

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

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Pennsylvania Hospital and Cardiology Group Settle FCA Suit for Over $20M

Posted  03/8/18
By the C|C Whistleblower Lawyer Team UPMC Hamot and Medicor Associates, a hospital and a cardiology group located in Erie, Pennsylvania, have settled allegations that they violated the Anti-Kickback Statute and the Stark Law, also known as the Physician Self-Referral Law. Generally speaking, the Anti-Kickback Statute prohibit hospitals, physicians, pharmacies, nursing homes, durable medical equipment (DME) companies,...

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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