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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,

Catch of the Week: Osteo Relief Institutes, Pedaling Dubious Treatment for Arthritis, Tagged for Charging Medicare for Medically Unnecessary Services

Posted 10/25/19

On October 18, 2019, the Department of Justice announced a settlement with arthritis treatment provider Osteo Relief Institutes and seven of its locations in Phoenix, Arizona; San Diego, California; Lexington, Kentucky; Wall Township, New Jersey; Dallas, Texas; San Antonio, Texas; and, Colorado Springs, Colorado. According to the DOJ press release, the ORI entities, together with their principals, will collectively...

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

Catch of the Week: Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M

Posted 10/11/19

Our latest Catch of the Week highlights the successful resolution of a whistleblower lawsuit against a Southern California eye doctor group and several individuals allegedly embroiled in a decade-long scheme to bill publicly funded healthcare programs for unnecessary eye exams. Ophthalmology provider group Retina Institute of California Medical Group (RIC), its former CEO, several of its doctors, and other involved...

Tagged in: Catch of the Week, FCA Federal, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

Fraud in Government Telehealth Programs: How to Report it Under the False Claims Act for a Whistleblower Reward

Posted 09/4/19

When patients are unable to see a doctor in person, technology can offer solutions. Telehealth or telemedicine is the provision of health services – including assessment, diagnosis, intervention, consultation, or supervision – across distance through the use of information technology. It can be especially valuable in rural areas, where specialty providers may not be available. And its use has grown...

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

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted 07/12/19

Pill container spilled over with pills fallen out.

On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

Tagged in: Anti-Kickback and Stark, FDA Fraud, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Provider Fraud,

DOJ Catch of the Week — Dr. Joseph Galichia

Posted 05/31/19

Paper Ripped Uncovering Medical Necessity Wording

This week's DOJ Catch of the Week goes to Kansas cardiologist Joseph Galichia. Yesterday, he agreed to pay $5.8 million to resolve allegations that he and his company, Galichia Medical Group, violated the False Claims Act by billing federal health care programs for medically unnecessary cardiac stent procedures. This is the government's third False Claims Act settlement with Dr. Galichia. Which may explain why he also...

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

$2.1 Million Whistleblower Settlement with Skyline Urology Resolves Allegations of Improper Unbundling Fraud

Posted 03/1/19

This week, the Department of Justice and Constantine Cannon LLP announced a $2.1 million settlement against Skyline Urology, at one time the largest urology practice in California. The settlement, which includes $1.85 million to the United States and $250,000 to the State of California, resolved allegations by our whistleblower client that Skyline had engaged in a systematic coding scheme to defraud Medicare and...

Tagged in: Bundling and Unbundling, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

Posted 12/14/18

Doctor discussing knee injury with patient seated on exam table

Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act for submitting false claims to Medicare and other federal health care programs for orthopedic surgeries. Coordinated Health is a for-profit hospital and health system based in the Lehigh...

Tagged in: Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

10th Circuit Finds that Doctor’s Judgment is Not Automatically Reasonable and Necessary

Posted 07/20/18

By Poppy Alexander Top-level heart surgeons work in a rarified world, where few may question their medical judgment. Yet that judgment is not infallible-and its presence is not in itself a protection against False Claims Act liability. The Tenth Circuit recently held as much in United States ex rel. Polukoff v. St. Mark’s Hospital et al., finding that a doctor may be exercising medical judgment while still...

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

Catch of the Week -- Healogics

Posted 06/22/18

This week's Department of Justice "Catch of the Week" goes to Healogics, Inc. On Wednesday, the Florida-based operator of hundreds of wound care centers agreed to pay up to $22.5 million to settle claims it violated the False Claims Act by billing Medicare for medically unnecessary and unreasonable hyperbaric oxygen therapy. See DOJ Press Release. Hyperbaric therapy involves breathing oxygen inside a pressurized...

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

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Top Ten Healthcare Fraud Recoveries of 2019

Catch of the Week: Osteo Relief Institutes, Pedaling Dubious Treatment for Arthritis, Tagged for Charging Medicare for Medically Unnecessary Services

Catch of the Week: Ophthalmology group, former CEO, and individual physicians settle fraud claims for $6.65M

Fraud in Government Telehealth Programs: How to Report it Under the False Claims Act for a Whistleblower Reward

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

DOJ Catch of the Week — Dr. Joseph Galichia

$2.1 Million Whistleblower Settlement with Skyline Urology Resolves Allegations of Improper Unbundling Fraud

Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations

10th Circuit Finds that Doctor’s Judgment is Not Automatically Reasonable and Necessary

Catch of the Week -- Healogics

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