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In Budget Testimony, Deputy AG Rod Rosenstein Includes Health Care Fraud Among DOJ Priorities

Posted 06/14/17

By the C|C Whistleblower Lawyer Team Deputy Attorney General Rod Rosenstein appeared Tuesday morning before members of the Appropriations Subcommittees to present the President’s Fiscal Year 2018 budget for the Department of Justice. Among key funding priorities, he noted the Department’s dedication “to good stewardship of taxpayer dollars,” and pointed to combatting health care fraud as an example of...

Tagged in: Healthcare Fraud,

In the Crosshairs: Medicare Advantage and Risk Adjustment Fraud

Posted 06/13/17

By the C|C Whistleblower Lawyer Team Listen to RAC Monitor's broadcast program, "In the Crosshairs: Medicare Advantage and Risk Adjustment Fraud," featuring Constantine Cannon Partner, Mary Inman. Ms. Inman also discusses Constantine Cannon’s recent $32.5 million settlement of the whistleblower case against Freedom Health, Optimum Healthcare, and Sidd Pagidipati involving allegations of risk adjustment fraud (at...

Tagged in: Managed Care,

Electronic Health Records Vendor Pays Big to Settle False Claims Act Charges

Posted 06/1/17

By the C|C Whistleblower Lawyer Team Massachusetts-based eClinicalWorks, one of the country's largest vendors of electronic health records software, agreed to pay $155 million to settle charges it violated the False Claims Act by misrepresenting the capabilities of its software and by paying kickbacks to certain customers in exchange for promoting the company's product. It is the largest False Claims Act settlement...

Tagged in: Contract Non-Compliance, Electronic Health Records, FCA Federal, Healthcare Fraud,

Eighth Circuit Rules That Public Disclosure Bar Applies in Drug Price Inflation Suit

Posted 05/31/17

Early this month, the U.S. Court of Appeals for the Eighth Circuit declined to revive a whistleblower’s False Claims Act (FCA) suit, ruling that prior litigation and government reports triggered the statutory public disclosure bar, even though the public disclosures at issue did not mention the defendants in the case. The case, United States ex rel. Lager v. CSL Behring. LLC, concerned fraud in the prescription drug...

Tagged in: Court Decision, FCA Federal, Pharma Fraud, Public Disclosure and Public Information,

Freedom Health, Optimum Healthcare and Its Former COO to Pay $32.5 Million to Settle False Claims Act Allegations of Medicare Fraud

Posted 05/31/17

By the C|C Whistleblower Lawyer Team Yesterday, the Department of Justice and Constantine Cannon, LLP announced that they had reached a settlement with Freedom Health and Optimum Healthcare, two large health insurers and operators of Medicare managed healthcare insurance plans controlled by Dr. Kiranbhai “Kiran” C. Patel and based in Tampa, Florida, to resolve allegations of systemic Medicare and Medicaid...

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

Houston-Area Psychiatrist Convicted of Health Care Fraud for Role in $158M Medicare Fraud Scheme

Posted 05/24/17

By the C|C Whistleblower Lawyer Team A jury convicted Texas psychiatrist Riaz Mazcuri of conspiracy to commit health care fraud and five counts of health care fraud. He is the latest to be convicted in a $158 million dollar scheme to defraud Medicare by submitting false claims for partial hospitalization program (PHP) services, an intensive outpatient treatment for mental illness. Thus far, 15 others have been...

Tagged in: Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

Trump to Propose Slashing Medicaid, Giving States Power to Limit Other Benefits

Posted 05/22/17

By the C|C Whistleblower Lawyer Team The Trump Administration plans to reveal its first major budget proposal on Tuesday and it will include large cuts to Medicaid and call for more state powers in limiting benefits. The Trump budget plan calls for a reduction of $800 billion to Medicaid over the next decade. The proposals also call for allowing states more flexibility to impose work requirements for people in...

Tagged in: Medicaid,

DOJ Catch of the Week -- Mercy Hospital

Posted 05/19/17

By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to two Southwest Missouri hospitals who yesterday agreed to pay $34 million to settle charges they violated the False Claims Act by engaging in improper financial relationships with referring physicians. The two hospitals are Mercy Hospital Springfield and its affiliate Mercy Clinic Springfield Communities (formerly...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal,

United States Files Complaint-in-Intervention in Constantine Cannon Whistleblower’s Case Against UnitedHealth Group

Posted 05/17/17

The Department of Justice announced yesterday that it has filed a complaint-in-intervention against UnitedHealth Group (UHG) in a case brought by Constantine Cannon client Ben Poehling. The government’s complaint alleges that UHG knowingly obtained inflated risk adjustment payments from Medicare Advantage based upon false information regarding the health of beneficiaries in its plans. UHG is the nation’s...

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

Poplar Healthcare to Pay Nearly $900k to Resolve Whistleblower’s False Claims Act Allegations

Posted 05/3/17

By the C|C Whistleblower Lawyer Team The Justice Department announced the settlement on Monday, which resolves allegations that Memphis’s Poplar Healthcare and its subsidiary GI Pathology promoted and billed the government for medically unnecessary diagnostic tests. Poplar allegedly marketed certain stain tests as capable of definitely diagnosing a condition called mast cell enterocolitis. But according to...

Tagged in: FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case,

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In Budget Testimony, Deputy AG Rod Rosenstein Includes Health Care Fraud Among DOJ Priorities

In the Crosshairs: Medicare Advantage and Risk Adjustment Fraud

Electronic Health Records Vendor Pays Big to Settle False Claims Act Charges

Eighth Circuit Rules That Public Disclosure Bar Applies in Drug Price Inflation Suit

Freedom Health, Optimum Healthcare and Its Former COO to Pay $32.5 Million to Settle False Claims Act Allegations of Medicare Fraud

Houston-Area Psychiatrist Convicted of Health Care Fraud for Role in $158M Medicare Fraud Scheme

Trump to Propose Slashing Medicaid, Giving States Power to Limit Other Benefits

DOJ Catch of the Week -- Mercy Hospital

United States Files Complaint-in-Intervention in Constantine Cannon Whistleblower’s Case Against UnitedHealth Group

Poplar Healthcare to Pay Nearly $900k to Resolve Whistleblower’s False Claims Act Allegations

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