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As States Look to Expand Health Coverage, State FCAs Become More Important than Ever

Posted 03/22/23

The increasing burden of healthcare costs has state governments looking at new programs to expand government healthcare options for their residents. Such an expansion of government spending will require a corresponding expansion of efforts to root out fraud, waste, and abuse that steals taxpayer dollars and reduces the benefits available. Existing anti-fraud measures, including state False Claims Acts, will play a...

Tagged in: FCA State, Government Programs Fraud, Healthcare Fraud, Medicaid, Medicare,

Healthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks

Posted 03/13/23

Very few cases ever filed reach jury trial. The vast majority are dismissed or settle long before that stage. This trend is particularly true for cases filed under the False Claims Act (FCA), where defendants face treble damages and penalties if they are found liable at trial. In FCA trials where the Government and/or whistleblower prevails, the judge, unbeknownst to the jury, is required to triple the amount of...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicare,

Top Ten State Fraud Recoveries of 2022

Posted 01/19/23

State and local governments play a critical role in ensuring that businesses and individuals are held accountable if they commit healthcare fraud, financial fraud, government contract fraud, and more. For whistleblowers, state governments can offer additional opportunities to report wrongdoing. Where government funds are at stake – and state and local government spending reaching $3 trillion annually – more...

Tagged in: FCA State, Financial and Investment Fraud, Government Procurement Fraud, Healthcare Fraud, Housing and Mortgage Fraud, Medicaid, Money Laundering, Private Insurance Whistleblower Reward Programs, Top 10,

Top Ten Healthcare Fraud Recoveries of 2022

Posted 01/6/23

Healthcare fraud image showing stethoscope with gavel

Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

Posted 08/24/22

Doctor with stethoscope on computer screen

Prior to the pandemic, telehealth was basically nonexistent, with one study clocking the percentage of “virtual” doctors’ visits before Covid-19 at zero percent. At the time, America’s largest insurer, Medicare, only covered telemedicine in limited circumstances that usually still involved a visit to a healthcare facility. Medicare’s coverage limitations demonstrated the Department of Health and Human...

Tagged in: COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Provider Fraud,

A recent case could undermine the rules that have been protecting taxpayer money from fraud since the time of Lincoln

Posted 06/24/22

Constantine Cannon whistleblower lawyers Eric Havian, Mike Ronickher, and Ari Yampolsky were published in Fortune.com on the Supreme Court's consideration of the SuperValu decision.

We’re whistleblower lawyers who spend our careers speaking in legalese. But every once in a while, a case comes along that is so alarming, yet so couched in jargon, that an issue of great importance can easily escape notice. When that...

Tagged in: CC Lawyers, Court Decision, Defenses, FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

Gordon Schnell and Max Voldman Published in Newsweek on How Whistleblowers are Key to Reining in Prescription Drug Costs

Posted 04/21/22

Newsweek published an OpEd by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman on the need to expand the Medicaid Drug Rebate Program to Medicare. The piece was prompted by DOJ's recent $235 million settlement with U.K. and St. Louis-based pharma company Mallinckrodt for allegedly violating the Medicaid rebate rule. On the books since 1990, the rule requires drug companies to rebate state...

Tagged in: CC Lawyers, Drug and DME Pricing, Healthcare Fraud, Medicaid, Medicare, Pharma Fraud,

Catch of the Week: Feds Shut The Door on an Uncommon Fraud Scheme involving New York Indigent Care Pool

Posted 02/3/22

The Southern District of New York announced a $12.9 million settlement with healthcare provider The Door, which provided services to uninsured youth for which it received reimbursement from New York State’s Indigent Care Pool. The settlement demonstrates the importance of whistleblowers, including the two that brought this case and stand to share in up to 25% of what the government collected, in helping to shut...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medicaid, Provider Fraud,

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Posted 01/28/22

A federal judge in Texas sentenced Bradley Harris, former head of Novus Health Services, Inc. hospice company in Frisco, to more than thirteen years in prison and ordered him to pay $27.6 million in restitution. The sentence, announced in a DOJ press release, follows his guilty plea on charges of conspiracy and fraud on Medicare and Medicaid. Harris is the latest to be sentenced in a fraud scheme spanning...

Tagged in: Catch of the Week, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Improper Medical Facility, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare,

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,

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As States Look to Expand Health Coverage, State FCAs Become More Important than Ever

Healthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks

Top Ten State Fraud Recoveries of 2022

Top Ten Healthcare Fraud Recoveries of 2022

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

A recent case could undermine the rules that have been protecting taxpayer money from fraud since the time of Lincoln

Constantine Cannon whistleblower lawyers Eric Havian, Mike Ronickher, and Ari Yampolsky were published in Fortune.com on the Supreme Court's consideration of the SuperValu decision.

Gordon Schnell and Max Voldman Published in Newsweek on How Whistleblowers are Key to Reining in Prescription Drug Costs

Catch of the Week: Feds Shut The Door on an Uncommon Fraud Scheme involving New York Indigent Care Pool

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

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