Catch of the Week Archives - Page 2 of 29

Catch of the Week: Classic Medicare Fraud

Posted 11/5/21

For those like your correspondents who spend their days deep in the weeds of complex Medicare fraud, it’s a delight when something refreshingly simple comes along. Thanks to Billy Joe Taylor of Arkansas, we can relax this Friday with a cool glass of straightforward Medicare fraud. For allegedly making $100 million in claims to CMS for tests that were not ordered or ever performed, he is our Catch of the...

Tagged in: Catch of the Week, COVID-19, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud,

Catch of the Week: Fraudulent Sleep Tests in Fresno

Posted 10/29/21

Fraud permeates through all aspects of America’s healthcare system- from hospitals to big pharma to chiropractors. This week’s catch of the week focuses on another part of the system, sleep clinics. As increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders, the significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous...

Tagged in: Catch of the Week, Healthcare Fraud, Improper Medical Facility, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

Posted 10/22/21

Clinical laboratory MD Labs Inc., and co-founders and owners, Denis Grizelj and Matthew Rutledge, settled charges the lab falsely billed Medicare, Medicaid, and other federal payors for pricey and unnecessary urine drug tests. Over a four-year period, the lab regularly ran two different drug tests at once and then sent results from both tests to the ordering healthcare physician simultaneously, according to the...

Tagged in: Catch of the Week, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

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,

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,

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,

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

Posted 09/24/21

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,

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

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,

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,

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

Catch of the Week: Classic Medicare Fraud

Catch of the Week: Fraudulent Sleep Tests in Fresno

Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

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

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

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

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

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

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

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

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.

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