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Catch of the Week: Telemarketer Gets 10 Years in $3.3 Million Telemedicine and Genetic Testing Fraud Scheme

Posted 04/16/21

Ivan Andre Scott, a 36-year-old Florida man, just landed a 10-year prison sentence for organizing a $3.3 million Medicare fraud scheme involving two of the hottest healthcare trends – telemedicine and genetic testing to assess the likelihood of future cancer. The conspiracy targeted vulnerable Medicare beneficiaries for pricey cancer screening genetic tests, prosecutors said. Claims for these tests were falsely...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

Catch of the Week: Founders of Poop-Testing Startup uBiome Face Fraud Charges

Posted 03/24/21

San Francisco-based uBiome and its founders Jessica Richman and Zachary Apte claimed they were “inventing the microbiome industry” and “making products that improve people’s lives.” Once considered a Silicon Valley success story, today, uBiome is bankrupt and its founders face various federal securities fraud and related criminal conspiracy charges. The biotech startup sold home medical tests including...

Tagged in: Catch of the Week, Criminal Proceedings, Improper Medical Facility, Medical Billing Fraud, Securities Fraud,

Catch of the Week: Unnecessary Blood Flow Tests Led to Unnecessary Flow of Healthcare Dollars

Posted 03/19/21

Doctor in handcuffs holding a stethoscope

Healthcare fraudsters routinely look for ways to extract money from federal health programs in ways that raise the least suspicion of their actions. One of these methods is through unnecessary diagnostic testing, which can often be lucrative when conducted routinely on large groups of patients. This week we focus on a recent settlement with Dr. Dinesh Shah and Michigan Physicians Group, P.C. (“MPG”) for $2...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Whistleblower Case,

The False Claims Act: It Benefits More than Just the Government

Posted 03/5/21

The False Claims Act, a Civil War-era law, encourages private individuals, such as whistleblowers, to come forward and file suit against unscrupulous government contractors, and share in the government's recovery. The passage of the law was inspired by contractors selling the Union Army bags of sand as flour, lame mules as cavalry horses, and glued-together rags as uniforms. The main purpose of the law is, of...

Tagged in: Dosage Fraud, Environmental Fraud, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Prevailing Wage,

Top Ten State Healthcare and Financial Fraud Recoveries of 2020

Posted 01/8/21

State and local governments are on the front lines of enforcing anti-fraud laws and play a critical role in ensuring that businesses and individuals are held accountable. Whistleblowers with information about corporate misconduct involving healthcare, government procurement, financial regulation, and tax may find that state proceedings offer them the best option. More than 30 states have False Claims Acts that...

Tagged in: Auto Safety, Drug and DME Pricing, FCA State, Financial and Investment Fraud, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Medical Billing Fraud, Pharma Fraud, Provider Fraud, Tax Fraud, Top 10,

COVID Fraud: New York Pharmacy Owners Indicted on Charges Arising from their Abuse of Emergency Override Billing Codes

Posted 01/7/21

As we have previously written, regulatory changes designed to alleviate logistical and financial pressure on healthcare providers during the COVID-19 crisis, while necessary, can create opportunities for fraudsters. Last month, an indictment in New York revealed a scheme by two pharmacy owners who took advantage of relaxed rules regarding prescription prior authorization and refill timing to overcharge Medicare and...

Tagged in: Catch of the Week, COVID-19, Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Pharma Fraud,

2020 Whistleblower of the Year Candidate – Dawn Wooten

Posted 01/5/21

Privately run immigration detention facilities have been a stain on our nation’s reputation for years now. The refugees and other immigrants who are detained within their walls suffer family separation, inadequate medical care, lack of basic necessities, inedible food, psychological torture, and even death from easily treatable diseases due to flimsy infection controls. The current pandemic crisis only amplifies...

Tagged in: Correctional Services Fraud, Human Rights, Importance of Whistleblowers, Improper Medical Facility, Whistleblower of the Year,

Constantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.

Posted 11/17/20

health insurance forms with stethoscope and calculator

Teresa Ross, a whistleblower represented by Constantine Cannon, and the Department of Justice have reached a settlement with Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative or GHC). The Medicare Advantage Organization (MAO) has agreed to pay $6.375 million to resolve allegations that the insurance plan improperly collected money from the Medicare Advantage program by overstating how...

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Medical Billing Fraud, Medicare, Risk Adjustment Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: 345 Charged in $6 Billion National Health Care Fraud and Opioid Takedown

Posted 10/2/20

Paper Ripped Uncovering Medical Necessity Wording

In the largest health care fraud and opioid enforcement action in the Justice Department’s history, 345 defendants—including more than 100 doctors, nurses, and other medical professionals—face charges for submitting over $6 billion in false or fraudulent claims to federal and private insurers. Defendants stand accused of submitting $4.5 billion in fraudulent claims linked to telemedicine, $845 million...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Pharma Fraud, Provider Fraud,

Windfall to Health Insurers Due to COVID-19 Is Not Yet Resulting in Resolution of FCA Risk Adjustment Cases

Posted 08/21/20

As health insurers book record profits during the COVID-19 pandemic due to a dramatic decline in elective surgeries and procedures, this seems like a good time to ask about the status of False Claims Act litigation against Medicare Advantage Organizations (MAOs) relating to risk adjustment fraud. Given the dire shortfall in state and federal money to fight the pandemic, when will MAOs begin paying back the billions...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Provider Fraud, Risk Adjustment Fraud, Upcoding, Whistleblower Eligibility,

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Catch of the Week: Telemarketer Gets 10 Years in $3.3 Million Telemedicine and Genetic Testing Fraud Scheme

Catch of the Week: Founders of Poop-Testing Startup uBiome Face Fraud Charges

Catch of the Week: Unnecessary Blood Flow Tests Led to Unnecessary Flow of Healthcare Dollars

The False Claims Act: It Benefits More than Just the Government

Top Ten State Healthcare and Financial Fraud Recoveries of 2020

COVID Fraud: New York Pharmacy Owners Indicted on Charges Arising from their Abuse of Emergency Override Billing Codes

2020 Whistleblower of the Year Candidate – Dawn Wooten

Constantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.

Catch of the Week: 345 Charged in $6 Billion National Health Care Fraud and Opioid Takedown

Windfall to Health Insurers Due to COVID-19 Is Not Yet Resulting in Resolution of FCA Risk Adjustment Cases

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