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Windfall to Health Insurers Due to COVID-19 Is Not Yet Resulting in Resolution of FCA Risk Adjustment Cases

Posted 08/21/20

As health insurers book record profits during the COVID-19 pandemic due to a dramatic decline in elective surgeries and procedures, this seems like a good time to ask about the status of False Claims Act litigation against Medicare Advantage Organizations (MAOs) relating to risk adjustment fraud. Given the dire shortfall in state and federal money to fight the pandemic, when will MAOs begin paying back the billions...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Provider Fraud, Risk Adjustment Fraud, Upcoding, Whistleblower Eligibility,

Press Round-Up: Settlement in Visiting Nurse Service of New York Case Described as Groundbreaking

Posted 07/2/20

The record-setting $57 million settlement in U.S. ex rel. Lacey v. Visiting Nurse Service of New York, a False Claims Act case brought by Constantine Cannon client Edward Lacey, received extensive coverage in the media, with stories noting that the wrongdoing alleged was “pervasive” in the home health industry. As a whistleblower, Lacey alleged that home health agency VNSNY failed to adhere to the plans of care...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medical Billing Fraud, Whistleblower Case,

Visiting Nurse Service of New York Settles Whistleblower Case Brought by Constantine Cannon Client for $57 Million

Posted 06/26/20

Constantine Cannon is pleased to announce a $57 million settlement of the False Claims Act lawsuit its whistleblower client brought against the Visiting Nurse Service of New York (VNSNY). VNSNY is the largest not-for-profit home health care agency in the country, serving roughly 150,000 patients a year in New York, most of whom are elderly and/or disabled. The whistleblower, Edward Lacey, was an executive at...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case,

DOJ Charges Healthcare CEO with Criminal Securities and Healthcare Fraud

Posted 06/12/20

Hands in handcuffs behind back of white man in business suit

In 2008, Rahm Emanuel, then-President Obama’s chief of staff, famously said, “You never want a serious crisis to go to waste. I mean, it’s an opportunity to do things that you think you could not do before.” However poorly phrased, generations of political and business leaders have understood the kernel of truth in his admonition. So have scammers and rip-off artists. We have been following the...

Tagged in: Catch of the Week, COVID-19, Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Market Manipulation and Trading Violations, Misrepresentations, Securities Fraud,

Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders, Write Mary Inman and Max Voldman in RACMonitor

Posted 06/10/20

attorney headshots of Mary Inman and Max Voldman

Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman updated their earlier reporting in RAC Monitor regarding the False Claims Act case brought by Integra Med Analytics against Texas-based hospital chain Baylor Scott & White. At the end of May, the Fifth Circuit Court of Appeals upheld a Texas district court opinion dismissing the case. As we have earlier written, Integra alleged that the...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Public Disclosure and Public Information, Upcoding, Whistleblower Eligibility,

Catch of the Week: Logan Laboratories and Tampa Pain Relief Centers for Urine Drug Testing Fraud

Posted 04/17/20

This week's Catch of the Week goes to Logan Laboratories, Inc. (Logan Labs), a reference laboratory in Tampa, Florida. Tampa Pain Relief Centers, Inc. (Tampa Pain), a pain clinic also based in Tampa, Florida, and two of their former executives who have agreed to pay a total of $41 million to resolve alleged violations of the False Claims Act for billing various federal health care programs for medically unnecessary...

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

Charges Filed in Shameful COVID-19 and Genetic-Cancer-Screening Test Scam

Posted 04/3/20

Erik Santos of Braselton, Georgia had run a fraudulent genetic cancer-screening-test scheme for months, then spotted an opportunity capitalize on fear surrounding COVID-19. According to the criminal complaint, Santos targeted elderly persons to determine if they met certain eligibility requirements for testing under government health-care programs. He passed the information along to co-conspirator testing...

Tagged in: Anti-Kickback and Stark, CC Lawyers, COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Laboratory and IDTF, Lack of Medical Necessity, Provider Fraud,

Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Posted 04/2/20

The HHS OIG recently released the Medicaid Fraud Control Units (MFCUs) Fiscal Year 2019 Annual Report, providing a consolidated accounting of the program’s success. MFCUs investigate and prosecute Medicaid fraud and patient abuse or neglect. MFCUs receive referrals from other agencies, the public, or via data mining with OIG approval. The referral is reviewed, an investigation is conducted, and the decision is...

Tagged in: Criminal Proceedings, Government Programs Fraud, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

Data Analysts: a New Kind of Whistleblower to “Catch a Rogue,” write Gordon Schnell and Max Voldman in Stat News

Posted 03/20/20

On March 16, 2019, STAT published an article by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman about a new kind of whistleblower emerging: the data-driven whistleblower. The article, Data analysts: a new kind of whistleblower to ‘catch a rogue’?, discusses different courts’ reaction to False Claims Act cases brought by Integra Med Analytics, a “forensic analysis firm that studies...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Public Disclosure and Public Information, Upcoding,

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Posted 03/6/20

In a significant win for whistleblowers, a federal appellate court held this week that, in order to determine liability under the False Claims Act, a whistleblower need not prove that a claim is “objectively” false. Instead, the Court held that, consistent with common law, a claim can be false under the FCA if based not on objectively verifiable facts, but on non-compliance with statutory or regulatory...

Tagged in: Court Decision, FCA Federal, Home Health and Hospice, Importance of Whistleblowers, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Eligibility,

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Windfall to Health Insurers Due to COVID-19 Is Not Yet Resulting in Resolution of FCA Risk Adjustment Cases

Press Round-Up: Settlement in Visiting Nurse Service of New York Case Described as Groundbreaking

Visiting Nurse Service of New York Settles Whistleblower Case Brought by Constantine Cannon Client for $57 Million

DOJ Charges Healthcare CEO with Criminal Securities and Healthcare Fraud

Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders, Write Mary Inman and Max Voldman in RACMonitor

Catch of the Week: Logan Laboratories and Tampa Pain Relief Centers for Urine Drug Testing Fraud

Charges Filed in Shameful COVID-19 and Genetic-Cancer-Screening Test Scam

Tracking Medicaid Fraud: HHS OIG Releases MFCU Annual Report

Data Analysts: a New Kind of Whistleblower to “Catch a Rogue,” write Gordon Schnell and Max Voldman in Stat News

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

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