Archive

Catch of the Week: National Health Care Fraud Sweep

Posted 06/30/23

This week's Department of Justice (DOJ) Catch of the Week goes to the 78 individuals criminally charged with participating in health care fraud and opioid abuse schemes across the country. On Wednesday, DOJ announced the "strategically coordinated, two-week nationwide law enforcement action" it brought with federal and state law enforcement partners, which targeted misconduct resulting in over $2.5 billion in...

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Pharma Fraud, Provider Fraud,

Catch of the Week: Smart Pharmacy, Inc.

Posted 06/16/23

This week's Department of Justice (DOJ) Catch of the Week goes to Florida-based compounding pharmacies Smart Pharmacy, Inc. and SP₂, and their owner Gregory Balotin. Yesterday, they agreed to pay at least $7.4 million to settle charges they violated the False Claims Act by adding an antipsychotic drug to topical pain creams solely to boost Medicare reimbursement. Not because of any medical purpose the drug...

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

It's Medicare Fraud Prevention Week - What Can You Do?

Posted 06/9/23

This week is Medicare Fraud Prevention Week. You probably did not even know it because of the relative lack of attention this important week has received. All the more surprising because Medicare fraud and abuse costs the government an estimated $60 billion per year. But according to Senior Medicare Patrol (SMP), the government-sponsored public education organization, there is a lot we can do to attack this...

Tagged in: FCA Federal, Healthcare Fraud, Medicare,

Catch of the Week: Detroit Medical Center

Posted 06/2/23

Handshake in room with dark window blinds

This week's Department of Justice (DOJ) "Catch of the Week" goes to Detroit Medical Center, Vanguard Health Systems, and Tenet Healthcare. On Wednesday, they agreed to pay roughly $30 million to settle government and whistleblower charges of violating the False Claims Act by providing kickbacks to certain referring physicians. It is just the latest in a string of False Claims Act settlements concerning kickbacks...

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

Catch of the Week: Vascular Surgeon Pays Over $60 Million for Defrauding Health Care Programs

Posted 05/26/23

This week's Department of Justice (DOJ) "Catch of the Week" goes to Michigan vascular surgeon Vasso Godiali. Yesterday, DOJ announced he was sentenced to 80 months in prison "for orchestrating a multimillion-dollar scheme to defraud health care programs by submitting claims for the placement of vascular stents and for thrombectomies that he did not perform." In addition to the jail time, Dr. Godiali also has to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

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,

DOJ FY2022 Annual Fraud Report Shows $2.2 Billion in Total Recoveries, with $1.9 Billion Thanks to Whistleblowers - But There are Reasons for Concern

Posted 02/8/23

DOJ Headquarters building seen from low angle

The Department of Justice released its annual report of civil recoveries for fraud and false claims against the U.S., showing $2.2 billion in settlements and judgments for the fiscal year ending September 2022. The data released by DOJ show the critical role that whistleblowers play in securing these recoveries for the government: of the $2.2 billion recovered, $1.96 billion – 89% – was recovered in cases...

Tagged in: COVID-19, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, Statistics,

Top Ten Federal Financial and Healthcare Fraud Prison Sentences of 2022

Posted 02/2/23

Financial and healthcare fraud often can carry stiff monetary penalties for entities facing government enforcement, as shown on our other Top Ten Lists. Whistleblowers reporting wrongful conduct under one of the federal whistleblower reward laws sometimes find that criminal authorities are as interested in their allegations as civil enforcement agencies and authorities. Fraud can also result in criminal charges and...

Tagged in: Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Ponzi Schemes, Tax Fraud, Top 10, Visa Fraud,

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,

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Catch of the Week: National Health Care Fraud Sweep

Catch of the Week: Smart Pharmacy, Inc.

It's Medicare Fraud Prevention Week - What Can You Do?

Catch of the Week: Detroit Medical Center

Catch of the Week: Vascular Surgeon Pays Over $60 Million for Defrauding Health Care Programs

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

DOJ FY2022 Annual Fraud Report Shows $2.2 Billion in Total Recoveries, with $1.9 Billion Thanks to Whistleblowers - But There are Reasons for Concern

Top Ten Federal Financial and Healthcare Fraud Prison Sentences of 2022

Top Ten State Fraud Recoveries of 2022

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