May 29, 2019

A doctor in South Carolina has agreed to pay $92,506.30 to settle allegations of accepting illegal payments from OK Compounding, LLC, in exchange for prescribing their pain creams to TRICARE patients.  The False Claims Act violations allegedly occurred between February and May 2013, and involved “medical director fees” paid to Dr. Jerry Back that were in reality, kickbacks.  This was the eighth kickback settlement in the Northern District of Oklahoma...

Fraud Related to Electronic Health Records

As the use of electronic health records (EHRs), also known as electronic medical records (EMRs), has expanded, so too has the fraud associated with EHRs. Individuals with knowledge of fraud related to EHR systems – whether in the form of false claims for EHR incentive payments, or in the form of false billings resulting from the use of EHRs – may be able to report their information by filing a...

Fraud in GSA Contracts: How to Report it Under the False Claims Act for a Whistleblower Reward

Federal government offices purchase all the products and services any office does: Office supplies, Telecommunications equipment and services, Computer hardware and software, Consulting services, Vehicles, Travel services, and so on. The General Services Administration is the centralized procurement arm for the federal government, overseeing tens of billions of dollars in procurement annually, as well as handling other government property management. With so much money at stake, GSA contracts have been...

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

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 $150M for the wrongdoing, prosecutors were not...

May 8, 2019

A South Florida woman who received kickbacks in exchange for patient referrals has been sentenced to over 7 years in prison. In exchange for at least $710,000, Yamilet Diaz allegedly referred Medicare beneficiaries to five home health agencies, aiding the agencies in unlawfully receiving over $1.6 million in reimbursements from Medicare that were tainted by the kickbacks. DOJ

Catch of the Week — Pharmaceutical Company Allegedly Bribed Doctors with Trips to the Kentucky Derby

A recent settlement between the Department of Justice and US WorldMeds (“USWM”), show how creative, and how luxurious, kickbacks allegedly paid to physicians can be. The company, a pharmaceutical manufacturer, agreed to pay $17.5M to resolve claims that it violated the False Claims Act by paying kickbacks to patients and doctors by boosting sales of two of their drugs, Apokyn (a drug used to treat Parkinson’s disease), and Myobloc (a...

May 8, 2019

Tea Kaganovich and Ramazi Mitaishvili, co-owners of New York Diagnostic Testing Centers, each pleaded guilty to health care fraud and conspiracy to defraud the lawful functions of the Internal Revenue Service (IRS). The couple submitted false health care claims for diagnostic testing services and paid over $18 million in kickbacks for the referral of beneficiaries who signed up for diagnostic testing and other alleged medical services. They fraudulently reported to the IRS that...

Pharmaceutical Fraud

Understanding the most common types of pharmaceutical industry fraud reported by whistleblowers. The pharmaceutical industry is regularly found to be engaging in fraud of many types, and whistleblowers are uniquely positioned to report this fraud to the government under the False Claims Act. Common Fraud in the Pharmaceutical Industry Includes: Unlawful Kickbacks Compounded drug fraud Illegal drug-switching Misuse of the 340B drug discount program Medicaid best price fraud Medicare Part...

May 3, 2019

Yazan B. Al-Madani, the last of four defendants who conspired to defraud the MetroHealth Hospital System was sentenced to over 10 years in prison. From 2008 through 2016, Madani and his co-conspirators defrauded MetroHealth out of hundreds of thousands of dollars through a multitude of bribes and kickbacks centered around the hospital’s dental program. Former hospital Chief Operating Officer, Edward R. Hills, was sentenced to more than 15 years in...

May 2, 2019

Insys Therapeutics executives were convicted for their part in a racketeering conspiracy where they defrauded Medicare and private insurance carriers. From May 2012 to December 2015, the defendants bribed medical practitioners to prescribe Subsys, an extremely addictive sublingual fentayl spray intended for use by cancer patients. In furtherance of these efforts, the defendants provided kickbacks to practitioners who increased their Subsys prescriptions. The defendants also defrauded health insurance providers who were hesitant...