Archive

Catch of the Week: Logan Laboratories and Tampa Pain Relief Centers for Urine Drug Testing Fraud

Posted 04/17/20

This week's Catch of the Week goes to Logan Laboratories, Inc. (Logan Labs), a reference laboratory in Tampa, Florida. Tampa Pain Relief Centers, Inc. (Tampa Pain), a pain clinic also based in Tampa, Florida, and two of their former executives who have agreed to pay a total of $41 million to resolve alleged violations of the False Claims Act for billing various federal health care programs for medically unnecessary...

Tagged in: Catch of the Week, FCA Federal, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Managed Care, Whistleblower Case,

Federal Audit Reveals Billions of Dollars in Medicare Advantage Overpayments

Posted 12/20/19

A new government report reveals what whistleblowers and their counsel have known for some time: the Medicare Advantage program is vulnerable to fraud committed by unscrupulous private health insurance companies, as well as their owners, vendors, affiliates, and even some doctors. These bad actors make patients enrolled in MA plans appear sicker than they actually are in order to increase their corporate profits. ...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Managed Care, Risk Adjustment Fraud,

Government Audit of Chronic Care Management Services Raises Serious Questions About Proposed Anti-Kickback Statute Safe Harbors

Posted 11/22/19

The U.S. Department of Health and Human Services is engaged in what it calls a “Regulatory Sprint to Coordinated Care,” in order to, in the words of HHS Deputy Secretary Eric Hargan, “update, reform, and cut back our regulations to allow innovation toward a more affordable, higher quality, value-based healthcare system.” On October 9, 2019, as part of this effort to “cut back” on regulations to advance...

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Managed Care, Medicaid, Medical Billing Fraud, Medicare,

New Yorker Article on Whistleblowers Features Constantine Cannon

Posted 01/28/19

Silver whistle hanging on cord in front of chalkboard

In an article titled “The Personal Toll of Whistle-Blowing” published in the February 4, 2019, New Yorker magazine, Sheelah Kolhatkar describes the cases of two Constantine Cannon whistleblower clients, and features whistleblower attorney Mary Inman. Focusing on False Claims Act cases involving fraud in the Medicare Advantage program, the article details how the FCA “effectively turned average citizens into a...

Tagged in: CC Lawyers, FCA Federal, Importance of Whistleblowers, Managed Care, Risk Adjustment Fraud,

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,

Listen: Expected Dismissal of Providence Health Upcoding Suit

Posted 12/7/18

Constantine Cannon partner Mary Inman joins the RAC Monitor “Monitor Monday” podcast to comment on the government’s decision to decline to intervene in a $188.1 million whistleblower lawsuit Med Analytics, LLC filed against Providence Health (now known as Providence St. Joseph) alleging Providence upcoded diagnoses it submitted to government health programs for reimbursement. Several reports have indicated the...

Tagged in: CC Lawyers, Managed Care, Upcoding, Whistleblower Case,

Watch: “Taking Advantage” Highlights Medicare Risk Adjustment Fraud

Posted 11/2/18

Constantine Cannon partner Mary Inman and two Constantine Cannon whistleblower clients are featured in Episode 3 of the PBS series “Playing by the Rules: Ethics at Work.” The episode investigates ”risk adjustment” in the Medicare Advantage program and practices by some of America’s largest insurance companies to make patients look sicker than they really are-which boosts payments to the insurance companies...

Tagged in: CC Lawyers, Healthcare Fraud, Managed Care, Risk Adjustment Fraud,

“Widespread and Persistent” Problems in Medicare Managed Care Burden Patients and Are Potential Violations of the False Claims Act

Posted 10/30/18

The federal government’s internal watchdog for the Medicare and Medicaid healthcare programs, the U.S. Department of Health and Human Services Office of the Inspector General (OIG), has issued a report finding that Medicare Advantage Organizations (MAOs) have engaged in a “widespread and persistent” practice of inappropriately denying coverage for medical services to Medicare patients. In addition, OIG has...

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Medicare,

Overpayment Rule Decision Doesn't Imperil Risk Adjustment Cases: Mary Inman and Max Voldman in RAC Monitor

Posted 10/19/18

On September 7, a federal district court in Washington, D.C. vacated a single Centers for Medicare & Medicaid Services regulation – the 2014 “overpayment rule.” As Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman write in RAC Monitor, many Medicare Advantage Organizations have since made bold statements about the significance of this decision and its impact on the series of False Claims...

Tagged in: CC Lawyers, FCA Federal, Managed Care, Medicare, Risk Adjustment Fraud,

Constantine Cannon Partner Jessica Moore on Court’s Decision in Medicare Advantage Case

Posted 07/23/18

Becker’s Hospital Review published Four Key Takeaways From 9th Circuit’s Resurrection of the Silingo Medicare Advantage Case, written by Constantine Cannon partner Jessica T. Moore. In the article, Ms. Moore analyzes the Ninth Circuit’s July, 2018, ruling in U.S. ex rel. Silingo v. WellPoint, Inc., a case brought by a whistleblower under the False Claims Act alleging risk adjustment fraud in Medicare’s Part C...

Tagged in: CC Lawyers, Court Decision, FCA Federal, FCA Pleading, Healthcare Fraud, Managed Care, Risk Adjustment Fraud, Whistleblower Case,

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Catch of the Week: Logan Laboratories and Tampa Pain Relief Centers for Urine Drug Testing Fraud

Federal Audit Reveals Billions of Dollars in Medicare Advantage Overpayments

Government Audit of Chronic Care Management Services Raises Serious Questions About Proposed Anti-Kickback Statute Safe Harbors

New Yorker Article on Whistleblowers Features Constantine Cannon

Top Ten Healthcare Recoveries of 2018

Listen: Expected Dismissal of Providence Health Upcoding Suit

Watch: “Taking Advantage” Highlights Medicare Risk Adjustment Fraud

“Widespread and Persistent” Problems in Medicare Managed Care Burden Patients and Are Potential Violations of the False Claims Act

Overpayment Rule Decision Doesn't Imperil Risk Adjustment Cases: Mary Inman and Max Voldman in RAC Monitor

Constantine Cannon Partner Jessica Moore on Court’s Decision in Medicare Advantage Case

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