Archive

First Circuit Weighs in on Supreme Court’s Materiality Standard in Escobar Remand

Posted 12/9/16

By Rosie Dawn Griffin The Supreme Court’s opinion in Universal Health Services, Inc. v. United States ex rel. Escobar—in which the high court upheld the implied false certification theory of liability but placed a new focus on materiality under the False Claims Act (FCA)—has predictably spawned a number of lower court decisions grappling with materiality in the varied factual landscape of FCA litigation,...

Tagged in: FCA Federal, FCA Materiality, Improper Medical Personnel,

Long Island’s Zwanger-Pesiri Radiology to Pay Over $10 Million Over Allegations of Medicare and Medicaid Fraud

Posted 11/17/16

By the C|C Whistleblower Lawyer Team Long Island Natives Reported Systemic and Abusive Billing Practices, Including: · performing unnecessary and excessive testing; · purposely scheduling tests based on financial gain, not patient need; · falsifying the identity of rendering radiologists while using the services of uncredentialed physicians; and · charging for services not performed. Constantine Cannon...

Tagged in: Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Rewards,

DOJ Catch of the Week -- Life Care Centers of America Inc.

Posted 10/28/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Life Care Centers of America Inc. On Monday, the Tennessee-based operator of more than 220 skilled nursing facilities, and its owner Forrest L. Preston, agreed to pay $145 million to resolve charges that Life Care violated the False Claims Act by submitting claims to Medicare and TRICARE for rehabilitation therapy...

Tagged in: Catch of the Week, FCA Federal, Other Government Health Programs,

Japanese Drug Manufacturer Nippon Forms Human Chain to Evade FDA Inspection

Posted 10/21/16

By the C|C Whistleblower Lawyer Team Talk about acting guilty. Japanese drug manufacturer Nippon Fine Chemical was so concerned about US Food and Drug Administration (FDA) violations that the quality control manager literally created a “shoulder-to-shoulder” wall of people in an attempt to prevent an FDA inspector from entering portions of the lab used to analyze drugs for US distribution. The attempted...

Tagged in: CGMP Violation,

Whistleblowers are Natural Allies in HHS OIG’s Effort to Crackdown on Improper Payments to Chiropractors

Posted 10/20/16

By the C|C Whistleblower Lawyer Team According to a new report by the Department of Health and Human Services’ Office of Inspector General (OIG), more than 80% of all Medicare payments for chiropractic services in 2013 went towards medically unnecessary procedures. As a result, the government spent nearly $359 million on unnecessary care. Although Medicare covers chiropractic services for active and corrective...

Tagged in: Healthcare Fraud,

Accountability Through Individual Prosecution: Former Tuomey CEO Pays $1 Million in False Claims Act Settlement

Posted 10/5/16

By Ronny Valdes On September 27, the Department of Justice (DOJ) announced former Tuomey Healthcare Systems CEO Ralph “Jay” Cox would pay $1 million to settle allegations related to his personal involvement in a fraudulent physician compensation scheme that violated the Stark Law and the False Claims Act (FCA). Tuomey, for its part, settled claims arising from the same scheme last year. In the original case...

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

DOJ Catch of The Week -- Vibra Healthcare

Posted 09/30/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Pennsylvania-based hospital chain Vibra Healthcare LLC. On Wednesday, the company agreed to pay $32.7 million to settle charges it violated the False Claims Act by billing Medicare for medically unnecessary services. Vibra operates roughly three-dozen long term care hospitals and inpatient rehabilitation...

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

DOJ Catch of The Week -- Vibra Healthcare

Posted 09/30/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Pennsylvania-based hospital chain Vibra Healthcare LLC. On Wednesday, the company agreed to pay $32.7 million to settle charges it violated the False Claims Act by billing Medicare for medically unnecessary services. Vibra operates roughly three-dozen long term care hospitals and inpatient rehabilitation...

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

“Meaningful Use” Meaningful Error: HHS OIG Finds over $11 Million in Incorrect EHR Incentive Payments

Posted 09/27/16

By Ronny Valdes On September 22, 2016, the U.S. Department of Health and Human Services Office of the Inspector General (HHS OIG) released a report finding that Washington State made incorrect Medicaid incentive payments for the “meaningful use” of electronic health records (EHR). The incentive payment structure was created by the Health Information Technology for Economic and Clinical Health Act (HITECH Act)...

Tagged in: Electronic Health Records, Medicaid,

DOJ Catch Of The Week -- North American Health Care

Posted 09/23/16

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to North American Health Care Inc. On Monday, the California-based operator of dozens of skilled nursing facilities -- along with its Chairman John Sorenson and Senior Vice President of Reimbursement Analysis Margaret Gelvezon -- agreed to pay $30 million to resolve charges they violated the False Claims Act by billing...

Tagged in: Catch of the Week, FCA Federal, Lack of Medical Necessity, Medicare, Other Government Health Programs, SNF,

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First Circuit Weighs in on Supreme Court’s Materiality Standard in Escobar Remand

Long Island’s Zwanger-Pesiri Radiology to Pay Over $10 Million Over Allegations of Medicare and Medicaid Fraud

DOJ Catch of the Week -- Life Care Centers of America Inc.

Japanese Drug Manufacturer Nippon Forms Human Chain to Evade FDA Inspection

Whistleblowers are Natural Allies in HHS OIG’s Effort to Crackdown on Improper Payments to Chiropractors

Accountability Through Individual Prosecution: Former Tuomey CEO Pays $1 Million in False Claims Act Settlement

DOJ Catch of The Week -- Vibra Healthcare

DOJ Catch of The Week -- Vibra Healthcare

“Meaningful Use” Meaningful Error: HHS OIG Finds over $11 Million in Incorrect EHR Incentive Payments

DOJ Catch Of The Week -- North American Health Care

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