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United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente

Posted 07/30/21

In a sign that the government’s enforcement efforts against fraud in the Medicare managed care system have reached a tipping point, the U.S. Department of Justice announced today that it is joining a portion of a whistleblower lawsuit brought by a Constantine Cannon client under the False Claims Act against Kaiser Permanente and affiliated entities, one of the nation’s largest managed-care organizations. ...

Tagged in: CC Lawyers, FCA Federal, Government Decision, Healthcare Fraud, Managed Care, Medicare, Risk Adjustment Fraud, Upcoding, Whistleblower Case,

Catch of the Week: EEG Testing Company and Private-Investment Company to Pay $15.3M for Kickback and False-Billing Allegations

Posted 07/23/21

man holding money in hand and another hand with one finger over mouth

Whistleblowers came forward with six False Claims Act actions against a national EEG testing company and an investment company for allegedly paying kickbacks and falsely billing government healthcare programs. Texas-based provider Alliance Family of Companies (now Stratus) and private investor Ancor Holdings together will pay $15.3 million to resolve the cases. For their actions in coming forward, two...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

FDA’s Approval of Alzheimer’s Drug Highlights Need for Whistleblowers

Posted 07/9/21

The Food and Drug Administration (FDA) is supposed to protect American consumers from unscrupulous private actors—charlatans, snake-oil salesmen, and the like—seeking to profit by selling unproven medical “cures,” treatments, and devices to the public. Emerging during the era of the robber barons as part of Theodore Roosevelt’s efforts to “civilize capitalism,” the FDA has prevented untold harm to...

Tagged in: FCA Federal, FDA Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicare, Pharma Fraud,

Catch of the Week: Medical Device Companies to Pay $38.75M Over Defective Coagulation Monitor Allegations Linked to Patient Deaths, Injuries

Posted 07/9/21

Medical device manufacturers Alere Inc. and Alere San Diego Inc. will pay nearly $40 million to resolve allegations that they knowingly sold defective blood coagulation monitors used by Medicare beneficiaries and falsely billed Medicare for the devices. The monitors are supposed to ensure that patients taking anticoagulant drugs receive a safe dosage to avoid life-threatening consequences from too much or too little...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare,

A New Day for Data Whistleblowers: DOJ Joins First False Claims Act Case Brought by Data Analysis Firm Whistleblower

Posted 06/17/21

In a potential watershed moment, data whistleblowing pioneer Integra Med Analytics secured their first government intervention in a False Claims Act case alleging Medicare billing fraud against a group of skilled nursing facilities in New York. Integra's action alleges that over the course of almost a decade, the fraud resulted in overcharges exceeding $129 million.

Integra's Data Whistleblowing

Integra purports to...

Tagged in: FCA Federal, Healthcare Fraud, SNF, Upcoding, Whistleblower Eligibility,

Catch of the Week: Dental Clinics to Pay $2.7M for Using Unsterilized Tools on Medicaid Patients

Posted 05/28/21

For over five years, Upper Allegheny Health Systems, a health care system operating several dental clinics in New York and Pennsylvania, allegedly performed dental services without sterilizing equipment between patients and falsely billed Medicaid for those services. After a former employee blew the whistle, the United States and the State of New York stepped in to investigate, and the defendant agreed to a $2.7...

Tagged in: Catch of the Week, FCA Federal, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Whistleblower Case,

DOJ Lowers The Boom On COVID-19 Healthcare Scams, Again

Posted 05/28/21

Hey, fraudsters, did you hear? There was a global pandemic, so the government pumped trillions of dollars into the economy. Probably a good time to get a piece of the cut, you ask? They’ll never find out, right? So many ways to grift! Well, not so much. From the start, the cops on the beat, led by the United States Department of Justice, have screamed from the rooftops: “Don’t do it. We WILL...

Tagged in: COVID-19, Criminal Proceedings, FCA Federal, Financial and Investment Fraud, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Laboratory and IDTF, Lack of Medical Necessity, Market Manipulation and Trading Violations, Medical Billing Fraud, Misrepresentations, Pharma Fraud, Securities Fraud,

Catch of the Week: Virginia OB/GYN Sentenced to 59 Years in Prison for Performing Medically Unnecessary Procedures for More Than Ten Years

Posted 05/21/21

Healthcare fraudsters are typically motivated by greed. But in satisfying that greed, some fraudsters perform reprehensible acts that permanently affect the victims of the fraud, making even the penalty they receive pale in comparison. This week we focus on the conviction of Javaid Perwaiz, an OB/GYN in Hampton Roads, Virginia, who was sentenced to 59 years in prison for performing medically unnecessary surgeries...

Tagged in: Catch of the Week, Criminal Proceedings, Falsifying Invoices, Healthcare Fraud, Improper Medical Facility, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

Catch of the Week: University of Miami to Pay $22 Million to Resolve Allegations of Lab Test Fraud

Posted 05/14/21

The University of Miami will pay $22 million to resolve three False Claims Act lawsuits, the first of which was filed in 2013. The government alleged that UM, which operates a medical school out of Jackson Memorial Hospital and an extensive health system spanning four south Florida counties, fraudulently billed government health care programs to boost declining revenues. Jackson Memorial will separately pay $1.1...

Tagged in: Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Dozens of Fraudsters Sentenced in Multimillion Dollar Compounding Pharmacy Fraud

Posted 04/30/21

On Thursday, an Alabama District Court Judge sentenced dozens of defendants to prison for participating in a massive conspiracy to swindle insurers for medically unnecessary compound drugs. The defendants included company executives and managers, a prescriber, billers, and sales representatives associated with Northside Pharmacy, which was doing business as Global Compounding Pharmacy (Global). According to the DOJ...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud, Whistleblower Case,

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United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente

Catch of the Week: EEG Testing Company and Private-Investment Company to Pay $15.3M for Kickback and False-Billing Allegations

FDA’s Approval of Alzheimer’s Drug Highlights Need for Whistleblowers

Catch of the Week: Medical Device Companies to Pay $38.75M Over Defective Coagulation Monitor Allegations Linked to Patient Deaths, Injuries

A New Day for Data Whistleblowers: DOJ Joins First False Claims Act Case Brought by Data Analysis Firm Whistleblower

Integra's Data Whistleblowing

Catch of the Week: Dental Clinics to Pay $2.7M for Using Unsterilized Tools on Medicaid Patients

DOJ Lowers The Boom On COVID-19 Healthcare Scams, Again

Catch of the Week: Virginia OB/GYN Sentenced to 59 Years in Prison for Performing Medically Unnecessary Procedures for More Than Ten Years

Catch of the Week: University of Miami to Pay $22 Million to Resolve Allegations of Lab Test Fraud

Catch of the Week: Dozens of Fraudsters Sentenced in Multimillion Dollar Compounding Pharmacy Fraud

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