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Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

Posted 12/14/18

Doctor discussing knee injury with patient seated on exam table

Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act for submitting false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health is a for-profit hospital and health system based in the Lehigh...

Tagged in: Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

When a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits

Posted 12/13/18

Pile of blister packs with medications of different colors and sizes

Imagine if at the end of Charles Dickens’ “A Christmas Carol,” Ebenezer Scrooge announced that he was giving the prize turkey to the Cratchit family for Christmas dinner, but that this “gift” was conditional upon Bob Cratchit agreeing to work even longer hours in the new year, the turkey being cooked in a certain way, and only certain family members eating it. Would we consider Scrooge to have been truly...

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud,

Listen: Expected Dismissal of Providence Health Upcoding Suit

Posted 12/7/18

Constantine Cannon partner Mary Inman joins the RAC Monitor “Monitor Monday” podcast to comment on the government’s decision to decline to intervene in a $188.1 million whistleblower lawsuit Med Analytics, LLC filed against Providence Health (now known as Providence St. Joseph) alleging Providence upcoded diagnoses it submitted to government health programs for reimbursement. Several reports have indicated the...

Tagged in: CC Lawyers, Managed Care, Upcoding, Whistleblower Case,

Catch of the Week — Actelion Pharmaceticals

Posted 12/7/18

Red and yellow capsules on top of U.S. currency

This week's Department of Justice "Catch of the Week" goes to Actelion Pharmaceuticals US, Inc., a California pharmaceutical company that sells various pulmonary arterial hypertension drugs, including Tracleer, Ventavis, Veletri, and Opsumit. Yesterday, Actelion agreed to pay $360 million to resolve allegations that it violated the Anti-Kickback Statute by indirectly paying drug copays for thousands of Medicare...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Pharma Fraud,

Watch: “Taking Advantage” Highlights Medicare Risk Adjustment Fraud

Posted 11/2/18

Constantine Cannon partner Mary Inman and two Constantine Cannon whistleblower clients are featured in Episode 3 of the PBS series “Playing by the Rules: Ethics at Work.” The episode investigates ”risk adjustment” in the Medicare Advantage program and practices by some of America’s largest insurance companies to make patients look sicker than they really are-which boosts payments to the insurance companies...

Tagged in: CC Lawyers, Healthcare Fraud, Managed Care, Risk Adjustment Fraud,

“Widespread and Persistent” Problems in Medicare Managed Care Burden Patients and Are Potential Violations of the False Claims Act

Posted 10/30/18

The federal government’s internal watchdog for the Medicare and Medicaid healthcare programs, the U.S. Department of Health and Human Services Office of the Inspector General (OIG), has issued a report finding that Medicare Advantage Organizations (MAOs) have engaged in a “widespread and persistent” practice of inappropriately denying coverage for medical services to Medicare patients. In addition, OIG has...

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Medicare,

Overpayment Rule Decision Doesn't Imperil Risk Adjustment Cases: Mary Inman and Max Voldman in RAC Monitor

Posted 10/19/18

On September 7, a federal district court in Washington, D.C. vacated a single Centers for Medicare & Medicaid Services regulation – the 2014 “overpayment rule.” As Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman write in RAC Monitor, many Medicare Advantage Organizations have since made bold statements about the significance of this decision and its impact on the series of False Claims...

Tagged in: CC Lawyers, FCA Federal, Managed Care, Medicare, Risk Adjustment Fraud,

Healthcare Fraud: it’s not just Medicare and Medicaid

Posted 10/17/18

Last year, the U.S. Department of Justice recovered $2.4 billion in settlements and judgments involving fraud in the healthcare industry perpetrated against government payors. But government programs like Medicare and Medicaid aren’t the only targets of massive healthcare fraud schemes. A recent Department of Justice press release announced the unsealing of a 32-count indictment containing charges against four...

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

Catch of the Week – AmerisourceBergen Corporation

Posted 10/12/18

Last Monday, one of the largest drug wholesalers in the country agreed to pay $625 million to settle allegations that it put cancer patients at risk by illegally repackaging and distributing millions of vials of oncology drugs. The federal government and forty-four states claimed that AmerisourceBergen Corp. (“ABC”) and one of its subsidiaries, Medical Initiatives, Inc. (“MII”) engaged in a thirteen-year-long...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Pharma Fraud, Whistleblower Case,

Catch of the Week — Health Management Associates

Posted 09/27/18

Health Management Associates, LLC (“HMA”), a former hospital chain now part of Community Health Systems, agreed on September 25th to a $260 million settlement to resolve allegations of false billing and kickbacks alleged in eight qui tam cases under the False Claims Act (“FCA”). HMA was a hospital chain headquartered in Tampa, Florida that was acquired by Community Health Systems Inc., a major U.S. hospital...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

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Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

When a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits

Listen: Expected Dismissal of Providence Health Upcoding Suit

Catch of the Week — Actelion Pharmaceticals

Watch: “Taking Advantage” Highlights Medicare Risk Adjustment Fraud

“Widespread and Persistent” Problems in Medicare Managed Care Burden Patients and Are Potential Violations of the False Claims Act

Overpayment Rule Decision Doesn't Imperil Risk Adjustment Cases: Mary Inman and Max Voldman in RAC Monitor

Healthcare Fraud: it’s not just Medicare and Medicaid

Catch of the Week – AmerisourceBergen Corporation

Catch of the Week — Health Management Associates

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