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Medicare Whistleblowers: The Most Common Questions Answered About Reporting Medicare Fraud

Posted 09/10/19

What potential whistleblowers need to know about reporting fraud in government healthcare programs.

Get answers to 6 common Medicare whistleblower questions

In this article, our experienced whistleblower attorneys have answered 6 of the most important and common questions posed by individuals who have knowledge of potential healthcare fraud, specifically, fraud in the Medicare program. Click the links below to...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Whistleblower Answers,

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,

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,

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Posted 08/2/19

This week marks the seventh year in a row that Congress has designated July 30^th National Whistleblower Day, honoring the occasion, on July 30, 1778, when the Continental Congress unanimously enacted the first whistleblower protection law in the United States. The law was passed in response to a petition to the Continental Congress filed by a group of ten American sailors and marines, who reported that their...

Tagged in: Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, Whistleblower Eligibility, Whistleblower Rewards,

Government Documents Dangerous Failures in Hospice-Care Facilities

Posted 07/19/19

The Department of Health and Human Services (HHS) recently released two deeply concerning reports about failures in hospice care. Hospices put patients in harm’s way by failing to meet Medicare’s standards of care, failing to protect patients from abuse, and failing to report dangerous conditions. All told, the reports paint a grim picture of substandard health services for a particularly vulnerable patient...

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted 07/12/19

Pill container spilled over with pills fallen out.

On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

Tagged in: Anti-Kickback and Stark, FDA Fraud, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Provider Fraud,

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,

Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Posted 06/7/19

Opioid manufacturer Insys Therapeutics agreed to a $225 million settlement related to allegations that it unlawfully marketed its drug Subsys and paid kickbacks to providers through “speaker programs” that rewarded providers who prescribed Subsys. We previously asked whether our readers thought CEOs should be more liable for corporate wrongdoing after the Insys CEO was convicted for participating in a criminal...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Question of the Week, Reporting to Government, Whistleblower Rewards,

Ohio Seeks to Recover Overcharges from OptumRx

Posted 02/21/19

After a 2018 investigation by the Ohio Bureau of Workers Compensation (BWC) of its prescription drug spending, the BWC pharmacy program manager, John Hanna, concluded that "we were being hosed." The BWC had contracted with OptumRx to act as a pharmacy benefits manager (PBM). PBMs act as middlemen between drugmakers, pharmacies, and payors such as worker's compensation programs, Medicaid, Medicare, and other...

Tagged in: FCA State, Medicaid, Other Government Health Programs, Pharma Fraud,

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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Medicare Whistleblowers: The Most Common Questions Answered About Reporting Medicare Fraud

Get answers to 6 common Medicare whistleblower questions

Is Data the Future of Whistleblowing?

DOJ Catch of the Week — Beaver Medical Group

This Week in Whistleblower History: National Whistleblower Day and the Creation of the Medicare and Medicaid Programs

Government Documents Dangerous Failures in Hospice-Care Facilities

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

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

Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Ohio Seeks to Recover Overcharges from OptumRx

Top Ten Healthcare Recoveries of 2018

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