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Top Ten Healthcare Fraud Recoveries of 2022

Posted 01/6/23

Healthcare fraud image showing stethoscope with gavel

Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

New York Times Covers “Cash Monster” of Risk Adjustment Fraud, Featuring Cases Initiated by Constantine Cannon Clients

Posted 10/11/22

Kaiser whistleblower Dr. James Taylor got the headline on the front page of Sunday’s New York Times: “The cash monster was insatiable.” The article, subtitled How Insurers Exploited Medicare for Billions, highlights that nearly half of the Medicare beneficiaries in the U.S. are now enrolled in Medicare Advantage programs. Federal payments to Medicare Advantage insurers make up a correspondingly increasing share...

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

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

Posted 08/24/22

Doctor with stethoscope on computer screen

Prior to the pandemic, telehealth was basically nonexistent, with one study clocking the percentage of “virtual” doctors’ visits before Covid-19 at zero percent. At the time, America’s largest insurer, Medicare, only covered telemedicine in limited circumstances that usually still involved a visit to a healthcare facility. Medicare’s coverage limitations demonstrated the Department of Health and Human...

Tagged in: COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Provider Fraud,

A recent case could undermine the rules that have been protecting taxpayer money from fraud since the time of Lincoln

Posted 06/24/22

Constantine Cannon whistleblower lawyers Eric Havian, Mike Ronickher, and Ari Yampolsky were published in Fortune.com on the Supreme Court's consideration of the SuperValu decision.

We’re whistleblower lawyers who spend our careers speaking in legalese. But every once in a while, a case comes along that is so alarming, yet so couched in jargon, that an issue of great importance can easily escape notice. When that...

Tagged in: CC Lawyers, Court Decision, Defenses, FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

American hospitals have been resistant to whistleblowers. Here’s how they can save money and lives by embracing them.

Posted 06/21/22

Last month, the American Hospital Association wrote a pointed letter to the Justice Department, asking them to investigate, and potentially sue, Medicare Advantage plans for improperly denying coverage of patients’ hospital services. Medicare Advantage is a popular government program that pays private insurers premiums to cover seniors, and the insurers are required by law to provide at least the same benefits as...

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers,

DOJ Ramps Up Enforcement Against COVID-19 Fraud

Posted 04/25/22

Even as mask restrictions are being relaxed in most parts of the country, the U.S. Department of Justice is ramping up its oversight of federal funds spent to fight the COVID-19 pandemic. Just last week, DOJ announced criminal charges against 21 defendants in nine federal districts for their alleged participation in COVID-19 fraud schemes that resulted in over $149 million in false billings to federal programs.

Tagged in: COVID-19, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud,

Gordon Schnell and Max Voldman Published in Newsweek on How Whistleblowers are Key to Reining in Prescription Drug Costs

Posted 04/21/22

Newsweek published an OpEd by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman on the need to expand the Medicaid Drug Rebate Program to Medicare. The piece was prompted by DOJ's recent $235 million settlement with U.K. and St. Louis-based pharma company Mallinckrodt for allegedly violating the Medicaid rebate rule. On the books since 1990, the rule requires drug companies to rebate state...

Tagged in: CC Lawyers, Drug and DME Pricing, Healthcare Fraud, Medicaid, Medicare, Pharma Fraud,

Constantine Cannon Whistleblower Practice Group 2021 Roundup: Another Banner Year

Posted 04/21/22

2021 was another banner year for Constantine Cannon’s whistleblower practice group, with three historic whistleblower successes, including the first-ever award under the Motor Vehicle Safety Whistleblower Act. This string of successes follows the firm's record-shattering 2020 year where our whistleblower team secured blockbuster settlements that recovered more than $600 million for the government and roughly $115...

Tagged in: Auto Safety, CC Lawyers, Dark Pools, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, SEC Whistleblower Reward Program, Whistleblower Rewards,

As Whistleblowers and Quality Care Advocates, Hospitalists are the Conscience of Healthcare

Posted 02/28/22

Thursday, March 3, 2022 is National Hospitalist Day, a day we recognize the contributions of the specialist care doctors and other professionals who provide quality care to sick and vulnerable patients in a hospital. As the fastest growing specialty in modern medicine, hospitalists are a critical part of the nation’s health care service delivery system. Less noted but no less important, hospitalists also play a...

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers, Upcoding,

Top 5 Reasons Why Nurses Make Great Whistleblowers

Posted 02/22/22

Nurses are rightly getting a lot of attention lately for the courageous and essential role they are playing on the front-line during the COVID-19 pandemic. Whether in hospitals, nursing homes, hospices, or as home health workers, nurses are finally “learning what they are worth,” even as private equity firms seek to profit from nurses’ increased wage-earning power. As reported by STAT, Congress is now...

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers, Whistleblower Eligibility,

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