Archive

Catch of the Week — Florida Hospital Chain CEO Settles False Billing Allegations

This week’s Catch of the Week highlights former hospital executive Gary D. Newsome’s settlement resolving false billing and kickback allegations. From 2008 to 2013, Newsome served as CEO of Naples, Florida-based hospital chain Health Management Associates, LLC (HMA). He will pay $3.46 million to resolve federal prosecutors’ claims that HMA, under his leadership, pressured doctors in the emergency department to...

Healthcare Fraud also Harms Private Insurers - and Whistleblowers can Help

Whistleblowers with information about healthcare fraud look first to the False Claims Act, and the impact that healthcare fraud has on Medicare, Medicaid, and other government healthcare spending.  But, healthcare fraud that harms private insurance companies – as opposed to government payors – also attracts government enforcement attention.  Several recent criminal prosecutions in Texas and elsewhere...

DOJ Announces Criminal Indictments in International Health Care Fraud Scheme that Caused $1.2 Billion in Medicare Losses

The U.S. Department of Justice announced this week that it had issued criminal indictments against two dozen individuals in one of the largest health care fraud schemes in U.S. history. The indictments target an alleged scheme involving the payment of illegal kickbacks and bribes by durable medical equipment (DME) companies in exchange for the referral of Medicare beneficiaries by doctors working with fraudulent...

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

MedStar Health, a health system in Maryland and Washington, DC, and two of its hospitals have settled allegations that they violated the False Claims Act by violating the Anti-Kickback Statute. The settlement is not a determination of liability. It settles specific allegations that MedStar paid kickbacks to MidAtlantic Cardiovascular Associates, a cardiology group based in Maryland, in exchange for...

Constantine Cannon Attorneys Gordon Schnell and Leah Judge Published in McKnight’s Senior Living on the DOJ's Recent Elder Fraud Sweep

Constantine Cannon attorneys Gordon Schnell and Leah Judge published an article in McKnight’s Senior Living discussing the Department of Justice’s recent elder fraud sweep.  The sweep involved more than 260 million defendants nationwide who were accused of running scams to fleece the elderly out of nearly $750 million. The article explains that the sweep is part of a broader agenda to enforce laws that protect...

Question of the Week — Are device manufacturer's services valuable education or unlawful kickbacks?

Earlier this week, medical-device manufacturer Medtronic's Covidien business unit agreed to pay approximately $20 million to resolve kickback allegations related to the sale of its ClosureFast radiofrequency ablation catheters.  ClosureFAST catheters are used in procedures to treat venous-reflux disease, whose symptoms include varicose veins. The settlement resolves claims that Covidien improperly provided doctors...

$2.1 Million Whistleblower Settlement with Skyline Urology Resolves Allegations of Improper Unbundling Fraud

This week, the Department of Justice and Constantine Cannon LLP announced a $2.1 million settlement against Skyline Urology, at one time the largest urology practice in California. The settlement, which includes $1.85 million to the United States and $250,000 to the State of California, resolved allegations by our whistleblower client that Skyline had engaged in a systematic coding scheme to defraud Medicare and...

Ohio Seeks to Recover Overcharges from OptumRx

After a 2018 investigation by the Ohio Bureau of Workers Compensation (BWC) of its prescription drug spending, the BWC pharmacy program manager, John Hanna, concluded that "we were being hosed."  The BWC had contracted with OptumRx to act as a pharmacy benefits manager (PBM).  PBMs act as middlemen between drugmakers, pharmacies, and payors such as worker's compensation programs, Medicaid, Medicare, and other...

Data Whistleblower Case Raises Question of What is a Public Disclosure

As regular readers know, we have been closely tracking the progress of data analysis firm Integra Med Analytics’ whistleblower lawsuit under the False Claims Act against Providence Health and its consultant J.A. Thomas and Associates, Inc. (JATA).  The case alleges a conspiracy between Providence and JATA to upcode for specific Major Complications or Comorbidities (MCCs). This case is part of a growing number of...

Catch of the Week – Justice Department Sues Tennessee Pharmacies and Pharmacists Illegally Dispensing Opioids

On Friday, the Justice Department announced that it has sued several pharmacies and pharmacists in Tennessee to stop them from illegally dispensing opioids. According to the complaint, both defendants have “fueled and profited from” the opioid epidemic by “repeatedly dispensing opioids and other controlled substances prone to abuse without a legitimate medical purpose and outside the usual course of professional...