Whistleblower News From The Inside — October 2, 2015

By the C|C Whistleblower Lawyer Team JPMorgan to pay a third of $1.86B swaps settlement -- JPMorgan Chase & Co is set to pay almost a third of a $1.86 billion settlement to resolve claims that a dozen big banks conspired to limit competition in the credit-default swaps market, with Morgan Stanley, Barclays Plc and Goldman Sachs Group paying about $230 million, $175 million and $164 million, respectively.  Reuters Strata...

September 29, 2015

The New Jersey Medicaid Fraud Control Unit and Office of the Insurance Fraud Prosecutor obtained an indictment against a doctor, Syed Jaffery, for accepting kickbacks in exchange for patient referrals. The indictment alleges that from 2010 to 2013, Jaffrey participated in a scheme by which he agreed to refer patients needing MRI and CT scans to Diagnostic Imaging Services of South Jersey in exchange for monetary kickbacks. Over the course...

DOJ’s Adventist Settlement Puts the Power of Whistleblowers in “Stark” Relief

By Tim McCormack and Molly Knobler (published on SCCE’s Compliance and Ethics Blog) There is no denying that certain aspects of the Physician Self-Referral Law, more commonly known as the “Stark Law,” are complicated. The Stark Law and its corresponding regulatory scheme include a web of technical terms, safe harbors, and interpretive guidance.   Is this complexity a necessary byproduct of the multi-faceted and increasingly sophisticated relationships between and among healthcare providers,...

Sleep-Disorder Fraud

Can one commit fraud while sleeping?  Sort of. Increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders that affect more than fifty million Americans.  The significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous to engage in fraudulent services and billing The most common method of diagnosing sleep disorders is a polysomnography test, which involves the monitoring and assessing of...

Stark Law Enforcement Trend: Hospital and Individual Physician Settle Allegations of Stark Law Violations and Illegal Upcoding

By Tim McCormack and Molly Knobler (published on SCCE’s Compliance and Ethics Blog) The Department of Justice’s (“DOJ”) recent string of victories against hospitals that have (allegedly) paid illegal inducements to employed physicians continues.  On September 4, 2015, DOJ settled two False Claims Act (“FCA”) suits with Columbus Regional Healthcare System (“Columbus”) and Dr. Andrew Pippas.  Columbus agreed to pay between $25 and $35 million (depending on its future financial performance)...

Whistleblower News From The Inside — September 16, 2015

By the C|C Whistleblower Lawyer Team Five air-traffic controller whistleblowers step forward -- According to the Office of Special Counsel, which expressed "deep gratitude" for the whistleblowers, they exposed a problem where pilots, air traffic control centers or airline dispatchers try to make changes to a flight plan by creating a second plan for the same flight.  PBS Florida hospital district to pay $69.5M to settle whistleblower charges -- The...

Whistleblower News from the Inside -- September 4, 2015

By the C|C Whistleblower Lawyer Team Tom Brady redeemed -- New York court nullifies the NFL's 4-game suspension of Patriot QB Brady, finding the arbitration award was procedurally unfair.  Whistleblower Insider Hospice chain and owner settle whistleblower False Claims Act charges -- St. Joseph Hospice Entities, which consists of 13 hospice facilities in Mississippi, Louisiana, Texas and Alabama, and its majority owner Patrick T. Mitchell agreed to pay $5,867,518 to...

Constantine Cannon And Department of Justice Continue Joint Pursuit Against California Sleep-Clinic Chain

By Jessica T. Moore Constantine Cannon LLP has filed an amended complaint on behalf of a whistleblower alleging multi-faceted fraud on the part of Bay Sleep Clinic and its owners and operators, and billing company Access Medical Consultants.  The filing in United States ex rel. Dresser v. Qualium Corp., et al, Civil Action No. 12-1745 in the Northern District of California, comes on the same day the United States reported that it...

Whistleblower News From The Inside — August 25, 2015

By the C|C Whistleblower Lawyer Team  Why phone fraud starts with a silent call -- "They're trying to see: Are they getting a human on the other end? You even cough and it knows you're there."  NPR  Health Care Solutions Network medical director convicted in $63M health care fraud scheme -- According to the evidence, the now-defunct partial hospitalization program billed Medicare and Medicaid for mental health services not medically...

August 24, 2015

The New York Attorney General announced settlement agreements with five defendants in a False Claims Act case that will return more than $8 million to the Medicaid and Medicare programs. The agreements resolve claims that SpecialCare Hospital Management Corporation defrauded Medicaid and Medicare by illegally referring patients to unlicensed drug and alcohol treatment programs in exchange for kickbacks. Investigation of the defendants began after whistleblowers Mathew I. Gelfand, M.D. and...