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Top Ten Healthcare Fraud Recoveries of 2019

Posted 01/24/20

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Top Ten Financial and Healthcare Fraud Prison Sentences of 2019

Posted 01/23/20

Prison tower and fence silhouetted against sky

Financial and healthcare fraud schemes can result not just in civil investigations and liability, but also in prison time for the individuals involved. In 2019, the Department of Justice obtained substantial prison sentences in numerous cases involving healthcare and financial frauds, helping to bring justice to the patients, investors, or individuals harmed by criminal fraudsters. Many of the fraudulent...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Ponzi Schemes, Top 10,

Catch of the Week: ResMed Pays $37.5 Million to Settle Five Qui Tam Cases Alleging Kickbacks

Posted 01/16/20

Sleep apnea equipment manufacturer ResMed agreed to pay $37.5 million to resolve allegations that it violated the False Claims Act and Anti-Kickback Statute by providing unlawful remuneration to durable medical equipment distributors, sleep labs, doctors, and other healthcare providers. It seems that ResMed’s kickback schemes struck many people as wrong: the settlement resolves five separate cases brought by...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Medical Devices and DME, Multiple Whistleblowers and First-to-File, Whistleblower Case,

Catch of the Week: Teva, A Pharmaceutical Company, Pays $54M to Settle Kickback Allegations

Posted 01/9/20

pill container spilled over with pills in the form of a dollar sign

A recent settlement between the Department of Justice and Teva, a pharmaceutical company, show how creative, and how hard to identify, kickbacks allegedly paid to physicians can be. The company has agreed to pay $54M to resolve claims when it violated the False Claims Act by paying kickbacks to doctors to boost sales of two of their drugs. Broadly speaking, the Anti-Kickback statute prohibits healthcare providers,...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Whistleblower Case, Whistleblower Protection Laws,

Government Audit of Chronic Care Management Services Raises Serious Questions About Proposed Anti-Kickback Statute Safe Harbors

Posted 11/22/19

The U.S. Department of Health and Human Services is engaged in what it calls a “Regulatory Sprint to Coordinated Care,” in order to, in the words of HHS Deputy Secretary Eric Hargan, “update, reform, and cut back our regulations to allow innovation toward a more affordable, higher quality, value-based healthcare system.” On October 9, 2019, as part of this effort to “cut back” on regulations to advance...

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Managed Care, Medicaid, Medical Billing Fraud, Medicare,

Catch of the Week: Tenet Healthcare to Pay $66M Over Kickback Allegations

Posted 11/7/19

Tenet Healthcare, a healthcare giant that operates 65 hospitals and conducts over 10 million patient encounters annually, has agreed in principle to pay the United States roughly $66M to settle allegations that it violated the Stark Law and the Anti-Kickback Statute. These laws generally prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Importance of Whistleblowers, SEC Whistleblower Reward Program, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors

Posted 10/30/19

Our Catch of the Week features a $20.25 million settlement with South Dakota-based Sanford Health, Sanford Medical Center, and Sanford Clinic announced by the Justice Department in an October 28, 2019 press release. The settlement resolves allegations the massive health system knowingly submitted claims for medically unnecessary spinal surgeries and tainted by kickbacks to a top Sanford neurosurgeon. Two Sanford...

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

Catch of the Week: Avanir Pharmaceuticals

Posted 09/27/19

Our Catch of the Week goes to Avanir Pharmaceuticals, manufacturer of Nuedexta, for allegedly paying kickbacks to physicians and engaging in false and misleading marketing tactics. Avanir allegedly marketed Nuedexta in long-term care facilities and targeted their sales tactics to encourage doctors to prescribe the drug to dementia patients for off-label uses. The pharma company agreed to pay over $108 million in...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Posted 09/18/19

On Monday, a federal judge in Houston sentenced Starsky Bomer, the former CFO and COO of Atrium Medical Center and Pristine Healthcare, to ten years in prison for his role in a Medicare fraud scheme that bilked the government of $16m. Bomer was convicted by a jury in October of last year. His co-conspirator, Dr. Sohail R. Siddiqui, took a plea deal in 2017 and is serving five years in prison. Bomer will do time...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Eligibility,

Question of the Week — Should Drug Companies that Defraud the Government Lose Their Patents?

Posted 09/18/19

Settlements between drug companies and the government are commonplace these days. Just last week the DOJ announced another settlement with a pharmaceutical company, Mallinckrodt, for allegedly paying kickbacks to doctors to induce them to prescribe more of the company’s drug. The company was accused of violating the Anti-Kickback Statute, which generally prohibits medical providers from paying or receiving...

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud, Question of the Week,

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Top Ten Healthcare Fraud Recoveries of 2019

Top Ten Financial and Healthcare Fraud Prison Sentences of 2019

Catch of the Week: ResMed Pays $37.5 Million to Settle Five Qui Tam Cases Alleging Kickbacks

Catch of the Week: Teva, A Pharmaceutical Company, Pays $54M to Settle Kickback Allegations

Government Audit of Chronic Care Management Services Raises Serious Questions About Proposed Anti-Kickback Statute Safe Harbors

Catch of the Week: Tenet Healthcare to Pay $66M Over Kickback Allegations

Catch of the Week: Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors

Catch of the Week: Avanir Pharmaceuticals

Catch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Question of the Week — Should Drug Companies that Defraud the Government Lose Their Patents?

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