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New Lawsuit Against Anthem Shows the Government’s Commitment to Medicare Advantage Fraud

Posted 04/3/20

health insurance with stethoscope and hundred dollar bills

Medicare Advantage, also called Medicare Part C, is ever-expanding part of our healthcare system. The program now insures over a third of total Medicare beneficiaries, well over 10 million people. An expansion in fraud has accompanied the program’s expansion, and the Department of Justice is zeroing in, with the Assistant Attorney General for the Civil Division, Joseph Hunt, recently declaring it a...

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Risk Adjustment Fraud,

Charges Filed in Shameful COVID-19 and Genetic-Cancer-Screening Test Scam

Posted 04/3/20

Erik Santos of Braselton, Georgia had run a fraudulent genetic cancer-screening-test scheme for months, then spotted an opportunity capitalize on fear surrounding COVID-19. According to the criminal complaint, Santos targeted elderly persons to determine if they met certain eligibility requirements for testing under government health-care programs. He passed the information along to co-conspirator testing...

Tagged in: Anti-Kickback and Stark, CC Lawyers, COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Laboratory and IDTF, Lack of Medical Necessity, Provider Fraud,

The Missing Ventilator Stockpile Was Not Inevitable

Posted 04/3/20

The coronavirus crisis has been a crash course for the general public in how lifesaving ventilators work. But the federal government has long known how crucial they are and how important it is to be able to stockpile sufficient numbers. Five years ago, the government tried to plan ahead by commissioning the design and production of a low-cost ventilator to build up public and private stores in case an...

Tagged in: Anti-Kickback and Stark, COVID-19, Drug and DME Pricing, FCA Federal, Healthcare Fraud,

Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Posted 04/2/20

The HHS OIG recently released the Medicaid Fraud Control Units (MFCUs) Fiscal Year 2019 Annual Report, providing a consolidated accounting of the program’s success. MFCUs investigate and prosecute Medicaid fraud and patient abuse or neglect. MFCUs receive referrals from other agencies, the public, or via data mining with OIG approval. The referral is reviewed, an investigation is conducted, and the decision is...

Tagged in: Criminal Proceedings, Government Programs Fraud, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

Loosening the Rules on Telehealth to Fight Coronavirus May Also Result in New Medicare Fraud Schemes

Posted 03/27/20

In response to the coronavirus pandemic, the U.S. government is loosening rules on telehealth to make it easier—and safer—for patients to speak to their healthcare providers. These steps are an important, and necessary, step to curtail the spread of the virus and to facilitate the treatment of infected patients. But it may also open the door to new telehealth fraud schemes by unscrupulous individuals and...

Tagged in: COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Whistleblower Rewards,

Data Analysts: a New Kind of Whistleblower to “Catch a Rogue,” write Gordon Schnell and Max Voldman in Stat News

Posted 03/20/20

On March 16, 2019, STAT published an article by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman about a new kind of whistleblower emerging: the data-driven whistleblower. The article, Data analysts: a new kind of whistleblower to ‘catch a rogue’?, discusses different courts’ reaction to False Claims Act cases brought by Integra Med Analytics, a “forensic analysis firm that studies...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Public Disclosure and Public Information, Upcoding,

The COVID-19 Crisis, Whistleblowers, and the Constantine Cannon Whistleblower Team

Posted 03/19/20

As Constantine Cannon announced earlier this week, in response to the coronavirus (COVID-19) crisis, we have implemented contingency plans to work remotely. While our work locations have changed, we remain dedicated to our whistleblower clients, and our team continues to provide whistleblowers with support and legal guidance. With offices in New York, D.C., San Francisco, and London, the Constantine Cannon...

Tagged in: CC Lawyers, COVID-19, Financial and Investment Fraud, Government Loan Programs, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Pharma Fraud,

As COVID-19 Spreads, So Does Consumer Fraud

Posted 03/13/20

“There currently are no vaccines, pills, potions, lotions, lozenges or other prescription or over-the-counter products available to treat or cure coronavirus disease 2019 (COVID-19).” This was the firm reminder sent to seven companies this week via FDA-FTC warning letters. The businesses were told to cease unproven efficacy claims in the marketing of their products, and were given 48 hours to respond to the...

Tagged in: COVID-19, Healthcare Fraud,

Medicaid Drug Rebate Fraud: Should it be an Enforcement Priority?

Posted 03/10/20

pill container spilled over with pills in the form of a dollar sign

Medicaid has one very intuitive approach to keeping drug prices in check. Drug companies, under a law called the Medicaid Drug Rebate Program, must rebate Medicaid programs any money that resulted from the increased drug prices outpacing inflation. Inflation is benchmarked to either 1990, or the first year a drug came to market, which ever is later. As an example of how this works, imagine a pharmaceutical company...

Tagged in: Drug and DME Pricing, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicaid, Pharma Fraud, Whistleblower Rewards,

DOJ Discusses Its 2020 Healthcare Fraud Enforcement Priorities

Posted 03/6/20

DOJ Headquarters building seen from low angle

In comments at the 2020 FBA Qui Tam conference, the Department of Justice reaffirmed its strong commitment to pursuing fraud under the False Claims Act and emphasized its particular focus on rooting out healthcare fraud. Jody Hunt, Assistant Attorney General in the Civil Division of DOJ, was encouragingly forceful in his comments about the critical role of the FCA in protecting the public fisc—and the patient...

Tagged in: Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Risk Adjustment Fraud,

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New Lawsuit Against Anthem Shows the Government’s Commitment to Medicare Advantage Fraud

Charges Filed in Shameful COVID-19 and Genetic-Cancer-Screening Test Scam

The Missing Ventilator Stockpile Was Not Inevitable

Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Loosening the Rules on Telehealth to Fight Coronavirus May Also Result in New Medicare Fraud Schemes

Data Analysts: a New Kind of Whistleblower to “Catch a Rogue,” write Gordon Schnell and Max Voldman in Stat News

The COVID-19 Crisis, Whistleblowers, and the Constantine Cannon Whistleblower Team

As COVID-19 Spreads, So Does Consumer Fraud

Medicaid Drug Rebate Fraud: Should it be an Enforcement Priority?

DOJ Discusses Its 2020 Healthcare Fraud Enforcement Priorities

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