Archive

Is Data the Future of Whistleblowing?

Posted 08/28/19

Two recent decisions, one in California and the other in Texas, might be signaling a new frontier in False Claims Act (FCA) litigation: the data-driven whistleblower. Both cases are brought by the same whistleblower, Integra. Integra is not a typical whistleblower, which are generally corporate insiders or other employees of a company that is accused of defrauding the government. Instead, Integra is a corporation that...

Tagged in: FCA Federal, FCA State, Hospital Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, Public Disclosure and Public Information, Whistleblower Case, Whistleblower Eligibility,

Question of the Week — Should Pharmacy Benefit Managers (PBMs) be allowed to deny patients access to essential life-saving drugs prescribed by their doctor?

Posted 08/19/19

As described in a recent article in The Fresno Bee, thousands of patients nation-wide have been denied access to essential life-saving medications by pharmacy benefit managers (PBMs) under the guise of ensuring that patients receive the most appropriate and cost-effective treatment. PBMs are the quintessential “middlemen” in the healthcare system, standing between patients and their physicians on one side, and...

Tagged in: Pharma Fraud, Question of the Week,

DOJ Catch of the Week — Beaver Medical Group

Posted 08/9/19

Yesterday, California-based Beaver Medical Group and one of its physicians, Dr. Sherif Khalil, agreed to pay roughly $5 million to resolve allegations they violated the False Claims Act by reporting invalid diagnoses to Medicare Advantage plans causing those plans to receive inflated payments from Medicare. It is the latest example of what has become a strong government commitment to pursuing fraud in the Medicare...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Posted 08/2/19

This week marks the seventh year in a row that Congress has designated July 30^th National Whistleblower Day, honoring the occasion, on July 30, 1778, when the Continental Congress unanimously enacted the first whistleblower protection law in the United States. The law was passed in response to a petition to the Continental Congress filed by a group of ten American sailors and marines, who reported that their...

Tagged in: Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, Whistleblower Eligibility, Whistleblower Rewards,

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted 07/26/19

Laboratory sample vial lying on procedure coding form

Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states. CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...

Tagged in: Anti-Kickback and Stark, Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,

Question of the Week — Will Healthcare Settlements Continue to Dominate False Claims Act Recoveries?

Posted 07/24/19

Recent blockbuster settlements continue past trends: healthcare fraud has so far this year dominated FCA recoveries. During the first half of 2019, the Department of Justice (“DOJ”) secured over $750 million in settlements from False Claims Act (“FCA”) cases. And just past the mid-year point, total recoveries have nearly doubled due to a $700 million civil settlement ($1.4 billion total) entered on July 11th...

Tagged in: FCA Federal, Government Programs Fraud, Healthcare Fraud, Housing and Mortgage Fraud, Pharma Fraud,

Government Documents Dangerous Failures in Hospice-Care Facilities

Posted 07/19/19

The Department of Health and Human Services (HHS) recently released two deeply concerning reports about failures in hospice care. Hospices put patients in harm’s way by failing to meet Medicare’s standards of care, failing to protect patients from abuse, and failing to report dangerous conditions. All told, the reports paint a grim picture of substandard health services for a particularly vulnerable patient...

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted 07/12/19

Pill container spilled over with pills fallen out.

On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

Tagged in: Anti-Kickback and Stark, FDA Fraud, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Provider Fraud,

New York Introduces Bills to Expand Whistleblower Protections

Posted 06/21/19

Under current law, whistleblowers who reported fraudulent activity in the government or other settings in the State of New York are typically barred from bringing other legal actions. Maybe not anymore. Last week, both the New York State Senate and Assembly signed off on a series of amendments aimed at providing greater protection for employees who notice and report illegal activity, and expanding the definition of a...

Tagged in: FCA State, Healthcare Fraud, Importance of Whistleblowers, Pharma Fraud, Retaliation, Whistleblower Eligibility, Whistleblower Protection Laws,

Question of the Week — Should providers who defraud Medicare be excluded from it?

Posted 06/18/19

Fortune Cookie with Message with Message Saying "Not Eligible for Medicare!"

Sometimes, though rarely, when a medical provider settles a False Claims Act case or is found to have violated the FCA at trial, they are excluded from participating in healthcare programs as a condition of resolving the case. Often, this is a limited-time ban that is meant to incentivize providers to follow Medicare’s rules in the future and to deter other providers from committing fraud. Between Medicare,...

Tagged in: FCA Federal, Medical Billing Fraud, Medicare, Question of the Week, Upcoding,

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Is Data the Future of Whistleblowing?

Question of the Week — Should Pharmacy Benefit Managers (PBMs) be allowed to deny patients access to essential life-saving drugs prescribed by their doctor?

DOJ Catch of the Week — Beaver Medical Group

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Question of the Week — Will Healthcare Settlements Continue to Dominate False Claims Act Recoveries?

Government Documents Dangerous Failures in Hospice-Care Facilities

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

New York Introduces Bills to Expand Whistleblower Protections

Question of the Week — Should providers who defraud Medicare be excluded from it?

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