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Catch of the Week – EHR Developer Greenway Health to Pay $57.25 Million to Settle FCA Allegations

Posted 02/8/19

Person in scrubs holding computer tablet projecting medical data

Electronic health records (EHR) software developer Greenway Health LLC agreed to pay $57.25 million to resolve allegations that it committed fraud by misrepresenting to its users the capabilities of its EHR product “Prime Suite” and by providing unlawful remuneration to users to induce them to recommend Prime Suite. Under the American Recovery and Reinvestment Act of 2009, the government made incentive payments...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Contract Non-Compliance, Electronic Health Records, FCA Federal, Healthcare Fraud,

Catch of the Week – Inform Diagnostics

Posted 02/1/19

Technician in laboratory safety wear using eyedropper to fill vials of blood

Texas-based pathology laboratory company Inform Diagnostics, formerly known as Miraca Life Sciences Inc., agreed on January 30th to a $63.5 million settlement to resolve allegations it violated the False Claims Act (“FCA”), the Anti-Kickback Statute (“AKS”), and the Stark Law by providing subsidies to referring physicians for electronic health record (“EHR”) technology as well as free or discounted...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Electronic Health Records, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Multiple Whistleblowers and First-to-File, Whistleblower Case,

Top Ten Healthcare Recoveries of 2018

Posted 01/15/19

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2018 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. Here are the top ten healthcare recoveries of 2018 by the numbers:

1. Amerisource Bergen Corporation - In...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Managed Care, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Risk Adjustment Fraud, Top 10,

When a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits

Posted 12/13/18

Pile of blister packs with medications of different colors and sizes

Imagine if at the end of Charles Dickens’ “A Christmas Carol,” Ebenezer Scrooge announced that he was giving the prize turkey to the Cratchit family for Christmas dinner, but that this “gift” was conditional upon Bob Cratchit agreeing to work even longer hours in the new year, the turkey being cooked in a certain way, and only certain family members eating it. Would we consider Scrooge to have been truly...

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud,

Catch of the Week — Actelion Pharmaceticals

Posted 12/7/18

Red and yellow capsules on top of U.S. currency

This week's Department of Justice "Catch of the Week" goes to Actelion Pharmaceuticals US, Inc., a California pharmaceutical company that sells various pulmonary arterial hypertension drugs, including Tracleer, Ventavis, Veletri, and Opsumit. Yesterday, Actelion agreed to pay $360 million to resolve allegations that it violated the Anti-Kickback Statute by indirectly paying drug copays for thousands of Medicare...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Pharma Fraud,

Catch of the Week — Health Management Associates

Posted 09/27/18

Health Management Associates, LLC (“HMA”), a former hospital chain now part of Community Health Systems, agreed on September 25th to a $260 million settlement to resolve allegations of false billing and kickbacks alleged in eight qui tam cases under the False Claims Act (“FCA”). HMA was a hospital chain headquartered in Tampa, Florida that was acquired by Community Health Systems Inc., a major U.S. hospital...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica

Posted 09/7/18

Whistleblower Marc Silver secured a victory from the Third Circuit on September 4, 2018, which held that his action was not blocked by the “public disclosure bar” of the False Claims Act, reversing a lower court that had dismissed his action. The Third Circuit’s opinion appropriately recognizes that a whistleblower can use non-public information as a bridge between public information and allegations of fraud,...

Tagged in: Anti-Kickback and Stark, Court Decision, FCA Federal, Healthcare Fraud, Medicaid, Part D, Pharma Fraud, Public Disclosure and Public Information,

Catch of the Week — Ambulance Company and Clients Busted for Illegal Kickbacks and Cozy Financial Relationships

Posted 08/31/18

Here’s a question you shouldn’t have to ask when you’re in an ambulance: Did a bribe put me here? Our Catch of the Week goes to a $21 million settlement of a case against several ambulance-industry companies for allegedly paying kickbacks to secure lucrative exclusive contracts. Paramedics Plus, the East Texas Medical Center, the Emergency Medical Services Authority (EMSA), and EMSA’s president and CEO Herbert...

Tagged in: Ambulance, Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week -- William Beaumont Hospital

Posted 08/3/18

This week’s Department of Justice “Catch of the Week” goes to William Beaumont Hospital, a regional hospital system based in the Detroit area. On Thursday, the company agreed to pay $84.5 million to resolve allegations under the False Claims Act of improper relationships with eight referring physicians, resulting in the submission of false claims to the Medicare, Medicaid and TRICARE programs. The settlement...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

Catch of the Week -- Health Quest Systems and Putnam Hospital Center

Posted 07/13/18

This week, DOJ announced a $14.7 million settlement with NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid, making Health Quest and Putnam our Catch of the Week. The settlement resolves allegations stemming from three separate lawsuits bought by...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Healthcare Fraud, Home Health and Hospice, Hospital Fraud, Medicaid, Medical Billing Fraud, Medicare, Multiple Whistleblowers and First-to-File, Upcoding, Whistleblower Case, Whistleblower Rewards,

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Catch of the Week – EHR Developer Greenway Health to Pay $57.25 Million to Settle FCA Allegations

Catch of the Week – Inform Diagnostics

Top Ten Healthcare Recoveries of 2018

When a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits

Catch of the Week — Actelion Pharmaceticals

Catch of the Week — Health Management Associates

Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica

Catch of the Week — Ambulance Company and Clients Busted for Illegal Kickbacks and Cozy Financial Relationships

Catch of the Week -- William Beaumont Hospital

Catch of the Week -- Health Quest Systems and Putnam Hospital Center

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