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Catch of the Week: Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M

Posted 10/11/19

Our latest Catch of the Week highlights the successful resolution of a whistleblower lawsuit against a Southern California eye doctor group and several individuals allegedly embroiled in a decade-long scheme to bill publicly funded healthcare programs for unnecessary eye exams. Ophthalmology provider group Retina Institute of California Medical Group (RIC), its former CEO, several of its doctors, and other involved...

Tagged in: Catch of the Week, FCA Federal, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

Catch of the Week: Avanir Pharmaceuticals

Posted 09/27/19

Our Catch of the Week goes to Avanir Pharmaceuticals, manufacturer of Nuedexta, for allegedly paying kickbacks to physicians and engaging in false and misleading marketing tactics. Avanir allegedly marketed Nuedexta in long-term care facilities and targeted their sales tactics to encourage doctors to prescribe the drug to dementia patients for off-label uses. The pharma company agreed to pay over $108 million in...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

Florida Pharma Whistleblower Case Results in FCA Settlement by Private Equity Firm

Posted 09/27/19

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

Last week, the government announced that compounding pharmacy Diabetic Care Rx LLC, known as Patient Care America (“PCA”), its executives, and the private equity firm managing the pharmacy Riordan, Lewis & Haden Inc., had agreed to pay over $21 million to settle allegations they violated the False Claims Act (“FCA”) by executing a kickback scheme to generate referrals of TRICARE patients. The allegations...

Tagged in: Compounding Pharmacy Fraud, Defendants, FCA Federal, FCA State, Healthcare Fraud, Importance of Whistleblowers, Pharma Fraud,

Catch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Posted 09/18/19

On Monday, a federal judge in Houston sentenced Starsky Bomer, the former CFO and COO of Atrium Medical Center and Pristine Healthcare, to ten years in prison for his role in a Medicare fraud scheme that bilked the government of $16m. Bomer was convicted by a jury in October of last year. His co-conspirator, Dr. Sohail R. Siddiqui, took a plea deal in 2017 and is serving five years in prison. Bomer will do time...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Eligibility,

Question of the Week — Should Drug Companies that Defraud the Government Lose Their Patents?

Posted 09/18/19

Settlements between drug companies and the government are commonplace these days. Just last week the DOJ announced another settlement with a pharmaceutical company, Mallinckrodt, for allegedly paying kickbacks to doctors to induce them to prescribe more of the company’s drug. The company was accused of violating the Anti-Kickback Statute, which generally prohibits medical providers from paying or receiving...

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud, Question of the Week,

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Posted 09/13/19

Philip Esformes, 50, of Miami Beach, Florida, was sentenced to 20 years in prison for his role in a decades-long billion-dollar scheme to submit fraudulent claims to Medicare and Medicaid both for services deemed medically unnecessary and services that were medically necessary but that he did not provide. Esformes personally pocketed $37 million from this scheme to fund his lavish lifestyle, while leaving elderly...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, SNF,

Medicare Whistleblowers: The Most Common Questions Answered About Reporting Medicare Fraud

Posted 09/10/19

What potential whistleblowers need to know about reporting fraud in government healthcare programs.

Get answers to 6 common Medicare whistleblower questions

In this article, our experienced whistleblower attorneys have answered 6 of the most important and common questions posed by individuals who have knowledge of potential healthcare fraud, specifically, fraud in the Medicare program. Click the links below to...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Whistleblower Answers,

Catch of the Week – Mallinckrodt Pays for Kickbacks on Acthar; Investigation into Copayment Subsidies Continues

Posted 09/6/19

This week, the Department of Justice announced that pharmaceutical company Mallinckrodt ARD LLC had agreed to pay over $15 million to resolve allegations that it paid illegal kickbacks to physicians to induce them to prescribe Acthar.

AKS Allegations

Two whistleblower lawsuits brought under the False Claims Act against Mallinckrodt alleged that from 2009 to 2013, the pharma company, then known as Questcor,...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Pharma Fraud, Whistleblower Eligibility, Whistleblower Rewards,

Fraud in Government Telehealth Programs: How to Report it Under the False Claims Act for a Whistleblower Reward

Posted 09/4/19

When patients are unable to see a doctor in person, technology can offer solutions. Telehealth or telemedicine is the provision of health services – including assessment, diagnosis, intervention, consultation, or supervision – across distance through the use of information technology. It can be especially valuable in rural areas, where specialty providers may not be available. And its use has grown...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud, Whistleblower Eligibility,

Question of the Week — Is the use of public nuisance law against J&J for its role in the opioid crisis appropriate?

Posted 08/29/19

The landmark $572M opioid verdict in Oklahoma against Johnson & Johnson stemmed from a single claim: “public nuisance” under state law. Other cases against opioid manufacturers, including whistleblower cases, involve claims for fraud, unlawful marketing, improper prescriptions, kickbacks, violating the Controlled Substances Act by failing to report suspicious purchases, and even flooding the black market. But...

Tagged in: Defendants, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week, Whistleblower Case,

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Catch of the Week: Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M

Catch of the Week: Avanir Pharmaceuticals

Florida Pharma Whistleblower Case Results in FCA Settlement by Private Equity Firm

Catch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Question of the Week — Should Drug Companies that Defraud the Government Lose Their Patents?

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Medicare Whistleblowers: The Most Common Questions Answered About Reporting Medicare Fraud

Get answers to 6 common Medicare whistleblower questions

Catch of the Week – Mallinckrodt Pays for Kickbacks on Acthar; Investigation into Copayment Subsidies Continues

AKS Allegations

Fraud in Government Telehealth Programs: How to Report it Under the False Claims Act for a Whistleblower Reward

Question of the Week — Is the use of public nuisance law against J&J for its role in the opioid crisis appropriate?

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