This archive includes posts from our “Catch of the Week” series, in which the Whistleblower Insider blog highlights particular government enforcement actions. Return to:
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...
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...
Catch of the Week: San Francisco Garbage Companies Cop to Bribing Corrupt City Regulator in $36 Million Deal with Feds
Posted 09/10/21
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...
Catch of the Week: Florida Lab Owner Pleads Guilty to $73 Million Telemedicine Fraud Scheme
Posted 09/3/21
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...
Catch of the Week: Florida Man Charged with Stealing Over $12 Million in Funds Slated for PPE
Posted 08/27/21
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...
Catch of the Week: Telemedicine Company Owner Charged in $784 Million Kickback Scheme
Posted 08/20/21
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...
Catch of the Week – Sour Grapes: Fruit-Broker Squashed for Role in Defrauding Federal Crop Insurance
Posted 08/13/21
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...
Catch of the Week: Waived Copayments and “Free” Glucometers Result in $160 Million Recovery in Whistleblower Action Against Previously-Barred Arriva Medical
Posted 08/4/21
Mail-order diabetes supply company Arriva Medical has agreed to pay $160 million to resolve a False Claims Act case filed in 2013 by a whistleblower who worked for ten months in one of the company’s call centers. The government intervened in the whistleblower’s action in early 2019, and the case had been set for trial in June 2022.
The settlement is the latest in a long string of actions against Arriva and...
Catch of the Week: EEG Testing Company and Private-Investment Company to Pay $15.3M for Kickback and False-Billing Allegations
Posted 07/23/21
Whistleblowers came forward with six False Claims Act actions against a national EEG testing company and an investment company for allegedly paying kickbacks and falsely billing government healthcare programs. Texas-based provider Alliance Family of Companies (now Stratus) and private investor Ancor Holdings together will pay $15.3 million to resolve the cases.
For their actions in coming forward, two...
Catch of the Week: Florida Department of Children and Families Pays $17.5 Million to Resolve Alleged SNAP Fraud
Posted 07/16/21
The Florida Department of Children and Families (FDCF) has agreed to pay$17,500,000 to resolve allegations that it violated the False Claims Act in its administration of the Supplemental Nutrition Assistance Program (SNAP).
The Program
The SNAP program provides eligible low-income individuals and families with financial assistance to buy nutritious food. Since 2010, SNAP has served on average more than 45 million...