Archive

Treble Damages Awarded in Medicare Whistleblower Case

Posted 02/21/20

The Fifth Circuit upheld a 2018 lower court decision this week, finding defendant BestCare Laboratory Services, LLC and its owner Karim Maghareh liable for treble damages—to the tune of just over $30 million—under the False Claims Act. BestCare provided clinical testing services for nursing home residents, many of whom were Medicare beneficiaries. Rather than billing for a technician’s travel to and from the...

Tagged in: Court Decision, Defenses, FCA Federal, Importance of Whistleblowers, Laboratory and IDTF, Medical Billing Fraud, Medicare, Whistleblower Case,

Catch of the Week: Guardian Elder Care

Posted 02/21/20

This week's DOJ Catch of the Week goes to Guardian Elder Care. On Wednesday, the operator of more than 50 nursing homes in Pennsylvania, Ohio and West Virginia agreed to pay roughly $15.5 million to resolve allegations it violated the False Claims Act by billing the government -- Medicare and the Federal Employees Health Benefits Program -- for medically unnecessary rehabilitation therapy services. According to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Improper Medical Facility, Improper Medical Personnel, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

Government Audit of Chronic Care Management Services Raises Serious Questions About Proposed Anti-Kickback Statute Safe Harbors

Posted 11/22/19

The U.S. Department of Health and Human Services is engaged in what it calls a “Regulatory Sprint to Coordinated Care,” in order to, in the words of HHS Deputy Secretary Eric Hargan, “update, reform, and cut back our regulations to allow innovation toward a more affordable, higher quality, value-based healthcare system.” On October 9, 2019, as part of this effort to “cut back” on regulations to advance...

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Managed Care, Medicaid, Medical Billing Fraud, Medicare,

Catch of the Week: Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors

Posted 10/30/19

Our Catch of the Week features a $20.25 million settlement with South Dakota-based Sanford Health, Sanford Medical Center, and Sanford Clinic announced by the Justice Department in an October 28, 2019 press release. The settlement resolves allegations the massive health system knowingly submitted claims for medically unnecessary spinal surgeries and tainted by kickbacks to a top Sanford neurosurgeon. Two Sanford...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Importance of Whistleblowers, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

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,

Catch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Posted 09/18/19

On Monday, a federal judge in Houston sentenced Starsky Bomer, the former CFO and COO of Atrium Medical Center and Pristine Healthcare, to ten years in prison for his role in a Medicare fraud scheme that bilked the government of $16m. Bomer was convicted by a jury in October of last year. His co-conspirator, Dr. Sohail R. Siddiqui, took a plea deal in 2017 and is serving five years in prison. Bomer will do time...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Eligibility,

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Posted 09/13/19

Philip Esformes, 50, of Miami Beach, Florida, was sentenced to 20 years in prison for his role in a decades-long billion-dollar scheme to submit fraudulent claims to Medicare and Medicaid both for services deemed medically unnecessary and services that were medically necessary but that he did not provide. Esformes personally pocketed $37 million from this scheme to fund his lavish lifestyle, while leaving elderly...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, SNF,

Question of the Week — Is the use of public nuisance law against J&J for its role in the opioid crisis appropriate?

Posted 08/29/19

The landmark $572M opioid verdict in Oklahoma against Johnson & Johnson stemmed from a single claim: “public nuisance” under state law. Other cases against opioid manufacturers, including whistleblower cases, involve claims for fraud, unlawful marketing, improper prescriptions, kickbacks, violating the Controlled Substances Act by failing to report suspicious purchases, and even flooding the black market. But...

Tagged in: Defendants, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week, Whistleblower Case,

Is Data the Future of Whistleblowing?

Posted 08/28/19

Two recent decisions, one in California and the other in Texas, might be signaling a new frontier in False Claims Act (FCA) litigation: the data-driven whistleblower. Both cases are brought by the same whistleblower, Integra. Integra is not a typical whistleblower, which are generally corporate insiders or other employees of a company that is accused of defrauding the government. Instead, Integra is a corporation that...

Tagged in: FCA Federal, FCA State, Hospital Fraud, Importance of Whistleblowers, Medical Billing Fraud, Medicare, Public Disclosure and Public Information, Whistleblower Case, Whistleblower Eligibility,

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Treble Damages Awarded in Medicare Whistleblower Case

Catch of the Week: Guardian Elder Care

Government Audit of Chronic Care Management Services Raises Serious Questions About Proposed Anti-Kickback Statute Safe Harbors

Catch of the Week: Sanford Health to pay over $20M for kickback, unnecessary spinal surgery claims brought by two Sanford doctors

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

Catch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Question of the Week — Is the use of public nuisance law against J&J for its role in the opioid crisis appropriate?

Is Data the Future of Whistleblowing?

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