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Catch of the Week: Feds Shut The Door on an Uncommon Fraud Scheme involving New York Indigent Care Pool

Posted 02/3/22

The Southern District of New York announced a $12.9 million settlement with healthcare provider The Door, which provided services to uninsured youth for which it received reimbursement from New York State’s Indigent Care Pool. The settlement demonstrates the importance of whistleblowers, including the two that brought this case and stand to share in up to 25% of what the government collected, in helping to shut...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medicaid, Provider Fraud,

DOJ Announces $5.7 Billion in FCA Recoveries in Fiscal Year 2021, with Boost from Purdue Settlement Claim

Posted 02/2/22

DOJ has released its annual announcement of recoveries in civil cases involving fraud and false claims against the government, and the total recoveries are eye-popping: $5.65 billion in settlements and judgments. These recoveries make FY2021 the second largest year in False Claims Act history, and the largest since 2014. As in prior years, healthcare fraud dominated, with more than $5 billion of the total...

Tagged in: FCA Federal, Government Procurement Fraud, Healthcare Fraud, Importance of Whistleblowers, Managed Care, Statistics,

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Posted 01/28/22

A federal judge in Texas sentenced Bradley Harris, former head of Novus Health Services, Inc. hospice company in Frisco, to more than thirteen years in prison and ordered him to pay $27.6 million in restitution. The sentence, announced in a DOJ press release, follows his guilty plea on charges of conspiracy and fraud on Medicare and Medicaid. Harris is the latest to be sentenced in a fraud scheme spanning...

Tagged in: Catch of the Week, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Improper Medical Facility, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare,

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Posted 01/28/22

Individuals involved in financial and healthcare fraud schemes face not just civil liability, but also criminal penalties – including prison time. In 2021, the Department of Justice obtained substantial prison sentences in a myriad of cases involving healthcare and financial frauds, many of which involved convictions of the type of fraudulent schemes that whistleblowers report. Whistleblowers play an essential role...

Tagged in: Compounding Pharmacy Fraud, COVID-19, Criminal Proceedings, Education Fraud, Financial and Investment Fraud, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare, Money Laundering, Ponzi Schemes, Securities Fraud, Top 10,

Top Ten State Fraud Recoveries of 2021

Posted 01/21/22

State enforcement of anti-fraud laws is an important deterrent and tool to create accountability. In cases of healthcare fraud and financial fraud, including government contract fraud, unlawful kickbacks, and tax evasion, state governments act as critical enforcement authorities, including through state False Claims Acts. Whistleblowers with information about fraud that violates state laws, or involves state...

Tagged in: FCA State, Financial and Investment Fraud, Healthcare Fraud, Top 10,

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Posted 01/14/22

The U.S. Attorney this week announced the arrest of doctors, businesspeople, an attorney, a New York police officer, and several others in one of the largest no-fault automobile insurance fraud takedowns in history. The investigation leading to their arrest was conducted by the U.S. Attorney’s Office for the Southern District of New York, the FBI, and the Westchester County District Attorney’s Office. The...

Tagged in: Catch of the Week, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

Top Ten Healthcare Fraud Recoveries of 2021

Posted 01/11/22

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Tagged in: Anti-Kickback and Stark, Chiropractic, Criminal Proceedings, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Catch of the Week: Jury Finds Teva Pharmaceuticals Liable for Contributing to Opioid-Related Deaths in New York State

Posted 01/7/22

In a significant development in the ongoing effort to assess blame and responsibility for the opioid epidemic, which has led to the deaths of hundreds of thousands of individuals and ravaged communities throughout the United States, on December 30^th, after a six-month trial, a New York jury found that Teva Pharmaceuticals USA, Inc. (“Teva”) and its affiliates, including Anda Inc., created a “public nuisance”...

Tagged in: Catch of the Week, Healthcare Fraud, Pharma Fraud,

Top Ten Whistleblower Awards of 2021

Posted 01/6/22

2021 was another banner year for whistleblowers, who once again collectively recovered billions of dollars for the government and hundreds of millions of dollars in whistleblower rewards under the various government whistleblower programs. This includes awards under the qui tam provisions of the federal False Claims Act and various state False Claims Act programs. It includes awards under the Dodd-Frank SEC...

Tagged in: Anti-Kickback and Stark, Auto Safety, CFTC Whistleblower Reward Program, FCA Federal, FCA State, Financial and Investment Fraud, Financial Institution Fraud, Healthcare Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, SEC Whistleblower Reward Program, Securities Fraud, Top 10, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: Pharmacy Owner Convicted in $174 Million Telehealth Fraud That Targeted Consumers and PBMs

Posted 12/10/21

In yet another example of how unscrupulous providers can take advantage of the benefits of telehealth (or telemedicine) to commit healthcare fraud, on December 2, 2021, a federal jury in Tennessee convicted Peter Bolos, the owner and operator of Synergy Pharmacy, located in Florida, of 22 criminal counts, including violating the Food, Drug and Cosmetic Act (FDCA) by introducing a misbranded drug into interstate...

Tagged in: Catch of the Week, Criminal Proceedings, Drug Switching, Healthcare Fraud, Medicaid, Pharma Fraud, Provider Fraud,

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Catch of the Week: Feds Shut The Door on an Uncommon Fraud Scheme involving New York Indigent Care Pool

DOJ Announces $5.7 Billion in FCA Recoveries in Fiscal Year 2021, with Boost from Purdue Settlement Claim

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Top Ten State Fraud Recoveries of 2021

Catch of the Week: 13 Conspirators Busted in $100 Million No-Fault Insurance Fraud

Top Ten Healthcare Fraud Recoveries of 2021

Catch of the Week: Jury Finds Teva Pharmaceuticals Liable for Contributing to Opioid-Related Deaths in New York State

Top Ten Whistleblower Awards of 2021

Catch of the Week: Pharmacy Owner Convicted in $174 Million Telehealth Fraud That Targeted Consumers and PBMs

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