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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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Medicare Fraud Alert: Inpatient Rehabilitation Hospitals

Posted  01/26/17
By the C|C Whistleblower Lawyer Team A recently-released report from Department of Health and Human Services Office of the Inspector General (HHS-OIG) revealed potentially serious problems related to Medicare beneficiary stays in inpatient rehabilitation hospitals. Such hospitals—either standalone or included as distinct units within general-purpose hospitals—are designed to address the needs of patients who...

The Importance of Medical Loss Ratio Minimum Requirements

Posted  01/24/17
By the C|C Whistleblower Lawyer Team We’ve covered Medical Loss Ratio (MLR) minimum requirements before. The MLR is, generally, the percentage of premium revenues an insurer spends on clinical services and quality improvements as opposed to on things like executive salaries, overhead, or marketing. Requiring a minimum MLR standard, something that the Federal Medicare Program does and several State Medicaid...

January 19, 2017

Nationwide retail pharmacy operator Walgreen Co. agreed to pay $50 million to settle charges it violated the False Claims Act and the Anti-Kickback Statute by enrolling hundreds of thousands of beneficiaries of government healthcare programs in its Prescription Savings Club program by inducing them with discounts and other monetary incentives. According to the government, Walgreens understood that allowing government beneficiaries to participate in the program was a violation of the Anti-Kickback Statute but nevertheless marketed the program to them anyway and paid its employees bonuses for each customer they enrolled in the program, without verifying whether the customers were government beneficiaries. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (SDNY)

Ninth Circuit Applies Escobar, Dismisses Whistleblower Suit against Government Contractor

Posted  01/18/17
By Hallie Noecker Last Thursday, the Ninth Circuit issued United States ex rel. Kelly v. Serco, Inc., the latest in a series of False Claims Act decisions—including in the First, Seventh, and Eighth Circuits—wrestling with the Supreme Court’s holding on materiality in Universal Health Services, Inc. v. United States ex rel. Escobar. Citing Escobar’s “rigorous” and “demanding” materiality standard,...

January 13, 2017

Massachusetts-based ambulance company Medstar Ambulance Inc., including four subsidiary companies and its two owners, Nicholas and Gregory Melehov, agreed to pay $12.7 million to resolve allegations that they violated the False Claims Act by submitting false claims to Medicare for ambulance transport services. According to the government, Medstar routinely billed for services that did not qualify for reimbursement because the transports were not medically reasonable and necessary, billed for higher levels of services than were required by patients’ conditions, and billed for higher levels of services than were actually provided. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dale Meehan, a former employee in Medstar’s billing office. Mr. Meehan will receive a whistleblower award of roughly $3.5 million. DOJ

January 12, 2017

Baxter International Inc. subsidiary Baxter Healthcare Corporation agreed to pay roughly $18 million to settle charges of violating the False Claims Act arising from the company's failure to follow current Good Manufacturing Practices when manufacturing sterile drug products in North Carolina. Baxter admitted that it distributed products in interstate commerce that were adulterated in violation of the Federal Food, Drug, and Cosmetic Act FDCA. It will pay a total of $16 million in monetary penalties and forfeiture. It will also pay roughly $2 million to resolve allegations it violated the False Claims Act by submitting false claims to the Department of Veterans Affairs based upon Baxter’s failure to follow cGMPs. The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by Baxter employee Christopher Wall. He will receive a whistleblower award of roughly $432,000 from the proceeds of the government's False Claims Act recovery. DOJ

January 11, 2017

Ireland-based Shire Pharmaceuticals LLC and certain subsidiaries agreed to pay $350 million to settle charges that Shire and the company it acquired in 2011, Advanced BioHealing violated the False Claims Act and Anti-Kickback Statute by using kickbacks and other unlawful methods to induce clinics and physicians to use or overuse their “Dermagraft” skin product. It is the largest False Claims Act recovery in a kickback case involving a medical device, and resolves claims brought by the federal government along with 37 states and the District of Columbia. The States will receive $6,104,000 for the State share of the Medicaid program. According to the government, Dermagraft salespersons unlawfully induced clinics and physicians with lavish dinners, drinks, entertainment and travel; medical equipment and supplies; unwarranted payments for purported speaking engagements and bogus case studies; and cash, credits and rebates. The allegations originated in six lawsuits filed brought by whistleblowers in, or transferred to, the United States District Court for the Middle District of Florida. Two of the qui tam actions named New York and other states and included allegations that Shire submitted or caused to be submitted false claims to the Medicaid program under federal and state False Claims Acts. The whistleblowers will receive a yet-to-be-determined whistleblower award from the proceeds of the government recovery. Whistleblower Insider, NY, FL

January 5, 2017

Ultimate Nursing Services of Iowa, Inc. and its president Steven Tucker Anderson agreed to pay $1 million to settle charges they violated the False Claims Act by submitting cost reports for non-reimbursable travel and entertainment expenses and for non-reimbursable costs associated with services provided to Ultimate Nursing by other entities owned by Anderson or a family member. DOJ (NDIA)

DOJ Catch of The Week -- Shire Pharmaceuticals

Posted  01/13/17
By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Ireland-based Shire Pharmaceuticals LLC.  On Wednesday, the company and certain subsidiaries agreed to pay $350 million to settle charges that Shire and the company it acquired in 2011, Advanced BioHealing (ABH), violated the False Claims Act and Anti-Kickback Statute by using kickbacks and other unlawful methods to...

Top-10 False Claims Act Kickback Recoveries For 2016

Posted  01/4/17
By the C|C Whistleblower Lawyer Team Here is our look-back at the top-10 Department of Justice False Claims Act recoveries in 2016 for violations of the Anti-Kickback Statute and/or the Stark Law.  Click here for a full chronological listing of all the DOJ False Claims Act recoveries in 2016.
  1. Lexington Medical Center -- The South Carolina hospital agreed to pay $17 million to resolve allegations it violated...
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