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Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Posted 01/28/22

Individuals involved in financial and healthcare fraud schemes face not just civil liability, but also criminal penalties – including prison time. In 2021, the Department of Justice obtained substantial prison sentences in a myriad of cases involving healthcare and financial frauds, many of which involved convictions of the type of fraudulent schemes that whistleblowers report. Whistleblowers play an essential role...

Tagged in: Compounding Pharmacy Fraud, COVID-19, Criminal Proceedings, Education Fraud, Financial and Investment Fraud, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare, Money Laundering, Ponzi Schemes, Securities Fraud, Top 10,

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Posted 01/14/22

The U.S. Attorney this week announced the arrest of doctors, businesspeople, an attorney, a New York police officer, and several others in one of the largest no-fault automobile insurance fraud takedowns in history. The investigation leading to their arrest was conducted by the U.S. Attorney’s Office for the Southern District of New York, the FBI, and the Westchester County District Attorney’s Office. The...

Tagged in: Catch of the Week, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

Top Ten Healthcare Fraud Recoveries of 2021

Posted 01/11/22

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Tagged in: Anti-Kickback and Stark, Chiropractic, Criminal Proceedings, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Top Ten Whistleblower Awards of 2021

Posted 01/6/22

2021 was another banner year for whistleblowers, who once again collectively recovered billions of dollars for the government and hundreds of millions of dollars in whistleblower rewards under the various government whistleblower programs. This includes awards under the qui tam provisions of the federal False Claims Act and various state False Claims Act programs. It includes awards under the Dodd-Frank SEC...

Tagged in: Anti-Kickback and Stark, Auto Safety, CFTC Whistleblower Reward Program, FCA Federal, FCA State, Financial and Investment Fraud, Financial Institution Fraud, Healthcare Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, SEC Whistleblower Reward Program, Securities Fraud, Top 10, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Classic Medicare Fraud

Posted 11/5/21

For those like your correspondents who spend their days deep in the weeds of complex Medicare fraud, it’s a delight when something refreshingly simple comes along. Thanks to Billy Joe Taylor of Arkansas, we can relax this Friday with a cool glass of straightforward Medicare fraud. For allegedly making $100 million in claims to CMS for tests that were not ordered or ever performed, he is our Catch of the...

Tagged in: Catch of the Week, COVID-19, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud,

Catch of the Week: Fraudulent Sleep Tests in Fresno

Posted 10/29/21

Fraud permeates through all aspects of America’s healthcare system- from hospitals to big pharma to chiropractors. This week’s catch of the week focuses on another part of the system, sleep clinics. As increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders, the significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous...

Tagged in: Catch of the Week, Healthcare Fraud, Improper Medical Facility, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

Posted 10/22/21

Clinical laboratory MD Labs Inc., and co-founders and owners, Denis Grizelj and Matthew Rutledge, settled charges the lab falsely billed Medicare, Medicaid, and other federal payors for pricey and unnecessary urine drug tests. Over a four-year period, the lab regularly ran two different drug tests at once and then sent results from both tests to the ordering healthcare physician simultaneously, according to the...

Tagged in: Catch of the Week, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

Catch of the Week: Private Equity Firm and Former Executives of a Mental Health Center Reach $25 Million Medicaid Settlement

Posted 10/15/21

dollar bill with Medicaid text ripped through

In recent years there has been a proliferation of private equity firms taking oversight of healthcare entities. These private equity firms have increased their exposure to False Claims Act liability by playing active roles in the operation of healthcare entities, and multiple settlements have been reached over the last two years (on kickbacks and promotion of unapproved use of drug-device systems on pediatric...

Tagged in: Catch of the Week, Defendants, FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud,

Catch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme

Posted 09/3/21

telemedicine doctor on computer with patient

Editor’s Note: For this week’s biggest story, the record $90 million settlement secured by a Constantine Cannon client against Sutter Health, read more here.

Healthcare fraudsters have a track record of exploiting health crises for personal gain. The COVID-19 pandemic created new telemedicine opportunities for patients to receive care without having to see doctors in person. As expected, fraudsters seized on...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Contract Non-Compliance, FCA Federal, Government Programs Fraud, Healthcare Fraud, Improper Medical Facility, Lack of Medical Necessity, Provider Fraud,

Medically Unnecessary Procedures Harm Patients, Raise U.S. Healthcare Costs, Atlantic Feature Emphasizes

Posted 08/20/21

surgeons operating on patient under bright lights

Unnecessary procedures have long plagued the U.S. healthcare system, costing taxpayers billions and subjecting thousands of patients to invasive procedures that sometimes do more harm than good. For decades, various government actors have acknowledged the problem.

Why then is it so difficult to prevent unnecessary procedures in the U.S.?

Reporter Chris Outcalt recently pondered in a piece for The Atlantic. The...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Whistleblower Case,

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Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Top Ten Healthcare Fraud Recoveries of 2021

Top Ten Whistleblower Awards of 2021

Catch of the Week: Classic Medicare Fraud

Catch of the Week: Fraudulent Sleep Tests in Fresno

Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

Catch of the Week: Private Equity Firm and Former Executives of a Mental Health Center Reach $25 Million Medicaid Settlement

Catch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme

Editor’s Note: For this week’s biggest story, the record $90 million settlement secured by a Constantine Cannon client against Sutter Health, read more here.

Medically Unnecessary Procedures Harm Patients, Raise U.S. Healthcare Costs, Atlantic Feature Emphasizes

Why then is it so difficult to prevent unnecessary procedures in the U.S.?

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