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Top Ten Healthcare Fraud Recoveries of 2019

Posted 01/24/20

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 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. Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Top Ten Financial and Healthcare Fraud Prison Sentences of 2019

Posted 01/23/20

Prison tower and fence silhouetted against sky

Financial and healthcare fraud schemes can result not just in civil investigations and liability, but also in prison time for the individuals involved. In 2019, the Department of Justice obtained substantial prison sentences in numerous cases involving healthcare and financial frauds, helping to bring justice to the patients, investors, or individuals harmed by criminal fraudsters. Many of the fraudulent...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Ponzi Schemes, Top 10,

Catch of the Week: ResMed Pays $37.5 Million to Settle Five Qui Tam Cases Alleging Kickbacks

Posted 01/16/20

Sleep apnea equipment manufacturer ResMed agreed to pay $37.5 million to resolve allegations that it violated the False Claims Act and Anti-Kickback Statute by providing unlawful remuneration to durable medical equipment distributors, sleep labs, doctors, and other healthcare providers. It seems that ResMed’s kickback schemes struck many people as wrong: the settlement resolves five separate cases brought by...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Medical Devices and DME, Multiple Whistleblowers and First-to-File, Whistleblower Case,

Catch of the Week: Teva, A Pharmaceutical Company, Pays $54M to Settle Kickback Allegations

Posted 01/9/20

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

A recent settlement between the Department of Justice and Teva, a pharmaceutical company, show how creative, and how hard to identify, kickbacks allegedly paid to physicians can be. The company has agreed to pay $54M to resolve claims when it violated the False Claims Act by paying kickbacks to doctors to boost sales of two of their drugs. Broadly speaking, the Anti-Kickback statute prohibits healthcare providers,...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Whistleblower Case, Whistleblower Protection Laws,

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,

Catch of the Week: Tenet Healthcare to Pay $66M Over Kickback Allegations

Posted 11/7/19

Tenet Healthcare, a healthcare giant that operates 65 hospitals and conducts over 10 million patient encounters annually, has agreed in principle to pay the United States roughly $66M to settle allegations that it violated the Stark Law and the Anti-Kickback Statute. These laws generally prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Importance of Whistleblowers, SEC Whistleblower Reward Program, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors

Posted 10/30/19

Our Catch of the Week features a $20.25 million settlement with South Dakota-based Sanford Health, Sanford Medical Center, and Sanford Clinic announced by the Justice Department in an October 28, 2019 press release. The settlement resolves allegations the massive health system knowingly submitted claims for medically unnecessary spinal surgeries and tainted by kickbacks to a top Sanford neurosurgeon. Two Sanford...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Importance of Whistleblowers, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Osteo Relief Institutes, Pedaling Dubious Treatment for Arthritis, Tagged for Charging Medicare for Medically Unnecessary Services

Posted 10/25/19

On October 18, 2019, the Department of Justice announced a settlement with arthritis treatment provider Osteo Relief Institutes and seven of its locations in Phoenix, Arizona; San Diego, California; Lexington, Kentucky; Wall Township, New Jersey; Dallas, Texas; San Antonio, Texas; and, Colorado Springs, Colorado. According to the DOJ press release, the ORI entities, together with their principals, will collectively...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

Media Round-Up: Our Whistleblower Lawyers in the Press

Posted 10/24/19

With whistleblowers continuing to dominate the headlines, lawyers from the Constantine Cannon whistleblower team have been published in and featured in a number of outlets. This week saw the following stories:

- Gordon Schnell and Max Voldman were published in FierceHealthcare, What’s Missing from the Debate about "Medicare for All"? Combating Billions in Healthcare Fraud. With Democratic candidates...

Tagged in: CC Lawyers, Financial and Investment Fraud, Healthcare Fraud, Importance of Whistleblowers, Whistleblower Eligibility,

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Top Ten Healthcare Fraud Recoveries of 2019

Top Ten Financial and Healthcare Fraud Prison Sentences of 2019

Catch of the Week: ResMed Pays $37.5 Million to Settle Five Qui Tam Cases Alleging Kickbacks

Catch of the Week: Teva, A Pharmaceutical Company, Pays $54M to Settle Kickback Allegations

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

Catch of the Week: Tenet Healthcare to Pay $66M Over Kickback Allegations

Catch of the Week: Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors

Catch of the Week: Osteo Relief Institutes, Pedaling Dubious Treatment for Arthritis, Tagged for Charging Medicare for Medically Unnecessary Services

Media Round-Up: Our Whistleblower Lawyers in the Press

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