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FCA Federal

This archive displays posts tagged as relevant to the federal False Claims Act. You may also be interested in the following pages:

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November 20, 2020

Information technology contractor Cognosante, LLC will pay $19 million to resolve allegations that it violated the False Claims Act by overcharging the government under two GSA Multiple Award Schedule contracts.  The settlement came after Cognosante disclosed to the U.S. that it provided false information concerning its commercial discounting practices during contract negotiations and, during contract performance, charged the government for labor that failed to meet the qualifications set forth in the contracts.  DOJ; USAO DC

Constantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.

Posted  11/17/20
health insurance forms with stethoscope and calculator
Teresa Ross, a whistleblower represented by Constantine Cannon, and the Department of Justice have reached a settlement with Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative or GHC).  The Medicare Advantage Organization (MAO) has agreed to pay $6.375 million to resolve allegations that the insurance plan improperly collected money from the Medicare Advantage program by overstating how...

Group Health Cooperative (now a subsidiary of Kaiser Permanente) – Medicare Advantage Fraud ($6.375 million)

Constantine Cannon represents whistleblower Teresa Ross against Group Health Cooperative, an insurance company that participates in the Medicare Advantage program. GHC has agreed to pay $6.375 million to resolve allegations that the insurance plan improperly collected money from the Medicare Advantage program by overstating how sick its beneficiaries were. Ms. Ross is a former employee of GHC, where she worked for 14 years; her most recent position was the director of risk adjustment services. In her complaint, Ms. Ross alleged that GHC had improperly relied on coders’ interpretations of diagnostic tests, prescriptions, and entries in problem lists to come up with diagnoses and that it had also submitted other codes that were false because they were diagnosed by inappropriate providers, fell outside service year, or the patient had no evidence of a current condition. See Press Release and Whistleblower Insider for more.

November 16, 2020

Seattle’s Group Health Cooperative, now part of Kaiser, will pay $6.375 million to settle allegations in a whistleblower suit that it falsely reported unsupported diagnosis codes to Medicare in order to receive inflated payments.  The suit alleges that GHC utilized the services of a coding review company, DxID, that proposed unsupported diagnosis codes, which GHC knowingly submitted to CMS as part of seeking higher payment for the affected Medicare Advantage beneficiaries.  Whistleblower Teresa Ross, represented by Constantine Cannon, will receive approximately $1.5 million.  DOJ

October 30, 2020

Days and Towers, LLC will pay over $800,000 to resolve charges that it violated the False Claims Act between 2015 and 2019 through its submission of false tariff schedules to reduce its customs obligations on imported products.  USAO PR

Catch of the Week: Guild Mortgage

Posted  10/30/20
stack of mortgage papers with gavel and money
We’re in the midst of a recession, 13 million Americans are out of work, GDP growth is slowing, and stock market volatility is approaching record-breaking levels. This recession is largely driven by the emergence of a mostly natural and random phenomenon, COVD-19, though there is plenty of blame to go around in how humans have reacted to the spread of the virus. This week’s catch of the week, however, harkens back...

Call to Albany: Time to reward insurance fraud whistleblowers

Posted  10/29/20
By Gordon Schnell, Max Voldman
Whistle on Wood
(Published in Times Union) Here is an idea for Albany. It would significantly strengthen the State's efforts to combat fraud, inject the State with tens of millions of dollars a year in added revenue, and most importantly, better protect the health and welfare of all New Yorkers. All it would entail is expanding New York's whistleblower rewards regime to include individuals exposing insurance fraud. New York...

October 29, 2020

Medtronic has agreed to pay over $9.2 million to resolve allegations of violating the False Claims Act and CMS’s Open Payments Program by paying kickbacks to a South Dakota-based neurosurgeon, Wilson Asfora, M.D., in order to induce sales of its SynchroMed II implantable intrathecal infusion pumps.  According to the government, Medtronic allegedly sponsored nine years’ worth of events at a restaurant owned by Asfora, and to which Asfora would invite his acquaintances, business partners, trusted colleagues, and referral sources.  For his role in the kickback scheme, Asfora has been named in a separate FCA lawsuit, which the United States joined last November.  USAO SD

Whistleblowing As a Civic Duty: Now Is the Time To Act

Posted  10/23/20
By Edward Baker
Whistleblower in Text
With voting in the 2020 election underway and the presidential debates behind us, now is a good time to reflect on the importance of civic duties to the preservation of American democracy.  Voting, paying taxes, serving on a jury, and registering with selective service are all examples of such duties—responsibilities which, if ignored or unfulfilled by enough individuals, will cause the institutional fabric holding...

October 22, 2020

Guild Mortgage Company, based in San Diego, has agreed to pay $25 million to resolve whistleblower-brought allegations of knowingly breaching material program requirements in connection with mortgages insured by the Federal Housing Administration (FHA).  As a participant of the FHA’s mortgage insurance program, Guild had the authority to originate and underwrite mortgages without government review for compliance with program rules. According to the former head of quality control, Kevin Dougherty, Guild failed to comply with those rules when it knowingly approved ineligible loans that later defaulted.  Dougherty will receive a relator’s share of nearly $5 million.  USAO SDCA
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