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DOJ Catch of the Week — Beaver Medical Group

Posted 08/9/19

Yesterday, California-based Beaver Medical Group and one of its physicians, Dr. Sherif Khalil, agreed to pay roughly $5 million to resolve allegations they violated the False Claims Act by reporting invalid diagnoses to Medicare Advantage plans causing those plans to receive inflated payments from Medicare. It is the latest example of what has become a strong government commitment to pursuing fraud in the Medicare...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted 07/26/19

Laboratory sample vial lying on procedure coding form

Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states. CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...

Tagged in: Anti-Kickback and Stark, Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,

Question of the Week — Should providers who defraud Medicare be excluded from it?

Posted 06/18/19

Fortune Cookie with Message with Message Saying "Not Eligible for Medicare!"

Sometimes, though rarely, when a medical provider settles a False Claims Act case or is found to have violated the FCA at trial, they are excluded from participating in healthcare programs as a condition of resolving the case. Often, this is a limited-time ban that is meant to incentivize providers to follow Medicare’s rules in the future and to deter other providers from committing fraud. Between Medicare,...

Tagged in: FCA Federal, Medical Billing Fraud, Medicare, Question of the Week, Upcoding,

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,

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Posted 05/24/19

Earlier this month, a Utah-based hospital chain announced it would settle whistleblower Dr. Gerald Polukoff’s case alleging the hospital performed unnecessary heart surgeries on Medicare patients, thereby overcharging the federal government in violation of the False Claims Act (FCA). Defendant Intermountain Health, the largest healthcare provider in the Intermountain West, had petitioned the U.S. Supreme Court to...

Tagged in: Court Decision, FCA Federal, FCA Pleading, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity,

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Posted 05/10/19

Handcuffed business-leader walking through jail.

In a shocking first, a federal jury has convicted an opioid-company CEO and other top executives of a criminal racketeering conspiracy. Insys founder and chairman John Kapoor and four other executives bribed doctors to overprescribe a highly addictive fentanyl painkiller, and ran a phony call-center to defraud insurance companies into paying for the expensive drug. Although the company itself had already paid over...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Defendants, Dosage Fraud, Healthcare Fraud, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week,

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

Posted 03/28/19

MedStar Health, a health system in Maryland and Washington, DC, and two of its hospitals have settled allegations that they violated the False Claims Act by violating the Anti-Kickback Statute. The settlement is not a determination of liability. It settles specific allegations that MedStar paid kickbacks to MidAtlantic Cardiovascular Associates, a cardiology group based in Maryland, in exchange for...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Whistleblower Case,

$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,

Data Whistleblower Case Raises Question of What is a Public Disclosure

Posted 02/21/19

Rows of chairs with people waiting in hospital billing office

As regular readers know, we have been closely tracking the progress of data analysis firm Integra Med Analytics’ whistleblower lawsuit under the False Claims Act against Providence Health and its consultant J.A. Thomas and Associates, Inc. (JATA). The case alleges a conspiracy between Providence and JATA to upcode for specific Major Complications or Comorbidities (MCCs). This case is part of a growing number of...

Tagged in: Court Decision, FCA Federal, Healthcare Fraud, Hospital Fraud, Public Disclosure and Public Information, Upcoding, 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,

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DOJ Catch of the Week — Beaver Medical Group

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Question of the Week — Should providers who defraud Medicare be excluded from it?

DOJ Catch of the Week — Dr. Joseph Galichia

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

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

Data Whistleblower Case Raises Question of What is a Public Disclosure

Top Ten Healthcare Recoveries of 2018

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