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Catch of the Week

This archive includes posts from our “Catch of the Week” series, in which the Whistleblower Insider blog highlights particular government enforcement actions.  Return to:

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Catch of the Week: Private Equity Firm and Former Executives of a Mental Health Center Reach $25 Million Medicaid Settlement

Posted  10/15/21
dollar bill with Medicaid text ripped through
In recent years there has been a proliferation of private equity firms taking oversight of healthcare entities. These private equity firms have increased their exposure to False Claims Act liability by playing active roles in the operation of healthcare entities, and multiple settlements have been reached over the last two years (on kickbacks and promotion of unapproved use of drug-device systems on pediatric...

Tagged in: Catch of the Week, Defendants, FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud,

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Catch of the Week: 18 Former N.B.A. Players Charged in Healthcare Fraud Scheme

Posted  10/8/21
Former professional basketball players, including Terence Williams, "Big Baby" Glen Davis, Sebastian Telfair, and Tony Allen, have been indicted for submitting fraudulent claims for reimbursement of medical and dental services not actually rendered. From 2017 through last year, defendants' scheme caused the N.B.A. Players' Health and Welfare Benefit Plan ("the Plan") to pay out nearly $4 million in false claims....

Tagged in: Catch of the Week, Criminal Proceedings, Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

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Catch of the Week: In hot water again, now for fleecing customers in foreign currency transactions, Wells Fargo pays $72m in fines and restitution

Posted  09/29/21
Wells Fargo Bank Banners on Side of Building
Earlier this week, the Department of Justice settled an important case in which Wells Fargo Bank agreed to pay over $70 million in penalties and restitution to defrauded bank customers. Wells Fargo admitted that it defrauded 771 customers, mostly small businesses, who used the bank’s foreign exchange services when they needed to send money overseas or receive money from abroad. Rather than charging standard fees for...

Tagged in: Catch of the Week, Financial and Investment Fraud, Financial Institution Fraud, FIRREA,

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Catch of the Week: CMS Suspends UnitedHealth and Anthem Medical Advantage Plans for Charging Too Much in Premiums

Posted  09/24/21
Medicare Card
CMS suspended three UnitedHealth Medicare Advantage (MA) plans and one Anthem MA plan this week for failing to meet federal Medical Loss Ratio requirements. The four plans – United of the Midwest, United of New Mexico, United of Arkansas, and Anthem’s MMM Healthcare – are prohibited from enrolling new members until 2023. MMM Healthcare is the largest MA plan in Puerto Rico, with more than 260,000...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Managed Care, Medicare,

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Catch of the Week: Bayada Home Health Care Settles Kickback Allegations for $17 Million in Case Demonstrating that Kickbacks Come in Many Forms

Posted  09/17/21
business person stamping a paper
Last week, Bayada Home Health Care, Inc., a national home health company with more than $1.5 billion in reported revenues and offices in twenty-two states, agreed to pay the United States $17 million to settle allegations that it violated the federal Anti-Kickback Statute (AKS).  The AKS prohibits paying illegal remuneration in any form to induce business or referrals paid for with federal health care dollars, and...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Home Health and Hospice, Whistleblower Case,

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Catch of the Week: San Francisco Garbage Companies Cop to Bribing Corrupt City Regulator in $36 Million Deal with Feds

Posted  09/10/21
Garbage Truck Men Loading Trash Behind Truck
Three San Francisco trash and recycling companies, all Recology, Inc. subsidiaries, have agreed to pay $36 million in a corruption scheme involving substantial bribes to former San Francisco Public Works Director Mohammad Nuru. The SF Recology Group, which includes Recology San Francisco, Sunset Scavenger Company, and Golden Gate Disposal & Recycling Company agreed to a deferred prosecution deal on charges they...

Tagged in: Bribery and Bid-Rigging, Catch of the Week, Government Procurement Fraud, Money Laundering,

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Catch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme

Posted  09/3/21
telemedicine doctor on computer with patient
Editor’s Note: For this week’s biggest story, the record $90 million settlement secured by a Constantine Cannon client against Sutter Health, read more here.
Healthcare fraudsters have a track record of exploiting health crises for personal gain. The COVID-19 pandemic created new telemedicine opportunities for patients to receive care without having to see doctors in person. As expected, fraudsters seized on...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Contract Non-Compliance, FCA Federal, Government Programs Fraud, Healthcare Fraud, Improper Medical Facility, Lack of Medical Necessity, Provider Fraud,

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Catch of the Week: Florida Man Charged with Stealing Over $12 Million in Funds Slated for PPE

Posted  08/27/21
person handcuffed with hands on stack of papers with briefcase
DOJ continues to make good on its promise to root out fraud in pandemic relief.  This week, a Florida resident Brian Sperber was indicted for defrauding hospitals and medical institutions out of more than $12 million dollars by falsely promising to deliver personal protective equipment to those purchasers. Sperber and his co-conspirators, who ran medical supply and logistics companies, took orders for N95 masks and...

Tagged in: Catch of the Week, COVID-19, Criminal Proceedings,

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Catch of the Week: Telemedicine Company Owner Charged in $784 Million Kickback Scheme

Posted  08/20/21
Doctor on computer with patient discussing medicine
Underscoring the fraud risks associated with the government’s continued expansion and loosening of restrictions on telehealth, the U.S. Department of Justice recently announced that a grand jury in New Jersey has returned a superseding indictment against the Florida owner of multiple telemedicine companies, referred to by DOJ prosecutors as the Video Doctor Network, for allegedly participating in a massive Medicare...

Tagged in: Catch of the Week, COVID-19, FCA Federal, Government Programs Fraud, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Medical Devices and DME, Medicare, Money Laundering, Whistleblower Rewards,

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Catch of the Week – Sour Grapes: Fruit-Broker Squashed for Role in Defrauding Federal Crop Insurance

Posted  08/13/21
Grapes
The manager of a California fruit broker learned the hard way that it doesn’t pay to assist in defrauding the Federal Crop Insurance Program.  The manager, at the behest of a grape farmer who sold crops through the broker, altered the farmer’s records to reflect lower-than-actual sales.  The falsified records assisted the farmer to claim crop-losses falsely and receive insurance-reimbursements funded by the...

Tagged in: Catch of the Week, Crop Insurance, FCA Federal, FIRREA, Flood Insurance, Private Insurance Whistleblower Reward Programs,

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