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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Loosening the Rules on Telehealth to Fight Coronavirus May Also Result in New Medicare Fraud Schemes

Posted  03/27/20
doctor-on-phone
In response to the coronavirus pandemic, the U.S. government is loosening rules on telehealth to make it easier—and safer—for patients to speak to their healthcare providers.  These steps are an important, and necessary, step to curtail the spread of the virus and to facilitate the treatment of infected patients.  But it may also open the door to new telehealth fraud schemes by unscrupulous individuals and...

March 20, 2020

A doctor in Florida has paid the United States $850,000 to settle claims of violating the Anti-Kickback and False Claims Acts.  In exchange for prescribing a powerful but highly addictive fentanyl spray, Subsys, to her patients, Dr. Parveen Khanna allegedly took illegal kickbacks from manufacturer Insys Pharmaceuticals, Inc that were disguised as speaker fees, then submitted claims for reimbursement to Medicare and TRICARE in violation of program rules prohibiting payment for kickback-induced services.  USAO MDFL

Data Analysts: a New Kind of Whistleblower to “Catch a Rogue,” write Gordon Schnell and Max Voldman in Stat News

Posted  03/20/20
data-analyst-on-laptop
On March 16, 2019, STAT published an article by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman about a new kind of whistleblower emerging: the data-driven whistleblower. The article, Data analysts: a new kind of whistleblower to ‘catch a rogue’?, discusses different courts’ reaction to False Claims Act cases brought by Integra Med Analytics, a “forensic analysis firm that studies...

The COVID-19 Crisis, Whistleblowers, and the Constantine Cannon Whistleblower Team

Posted  03/19/20
Soapy hands under running water faucet
As Constantine Cannon announced earlier this week, in response to the coronavirus (COVID-19) crisis, we have implemented contingency plans to work remotely.  While our work locations have changed, we remain dedicated to our whistleblower clients, and our team continues to provide whistleblowers with support and legal guidance. With offices in New York, D.C., San Francisco, and London, the Constantine Cannon...

March 13, 2020

Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, LLC, have agreed to pay $1.74 million to settle claims of submitting false and inflated claims to Medicare.  From 2011 to 2016, defendants billed and caused Medicare to pay for lower-level wound repairs as if they were more complex adjacent tissue transfers.  The misconduct was eventually exposed by whistleblowers Dr. Robert Green and Emily Kennedy, who will share in a $305,000 award.  USAO MDFL

As COVID-19 Spreads, So Does Consumer Fraud

Posted  03/13/20
Coronavirus Disease 2019 Graphic
“There currently are no vaccines, pills, potions, lotions, lozenges or other prescription or over-the-counter products available to treat or cure coronavirus disease 2019 (COVID-19).” This was the firm reminder sent to seven companies this week via FDA-FTC warning letters. The businesses were told to cease unproven efficacy claims in the marketing of their products, and were given 48 hours to respond to the...

March 11, 2020

Millennium Physicians Association PLLC, d/b/a Millennium Respiratory & Sleep Disorder Specialists, has agreed to pay $1.2 million to resolve whistleblower-brought allegations of fraud in connection with two sleep centers in Texas.  From 2015 to 2019, Millennium allegedly violated Medicare rules and the False Claims Act by improperly billing Medicare for sleep studies conducted without the presence of properly credentialed technicians.  As part of the settlement, the anonymous relator will receive a $187,344  share of the settlement.  USAO SDTX

March 11, 2020

The organizer of a $2 million multi-state Medicaid fraud scheme has been sentenced to 11 years in prison and ordered to pay $2.5 million in restitution.  Along with two other co-defendants, Matthew Harrell fraudulently obtained the Medicaid provider number of mental health service providers in Georgia and Florida, as well as the Medicaid member numbers of children in foster care, welfare, and other programs in Louisiana.  Using companies purporting to be mental health providers, the defendants then submitted $3.5 million in false claims and received $2.5 million in reimbursements. Harrell's co-defendants, Nikki Richardson and Tomeka Howard, have also been ordered to serve time and pay restitution.  USAO NDGA

Medicaid Drug Rebate Fraud: Should it be an Enforcement Priority?

Posted  03/10/20
pill container spilled over with pills in the form of a dollar sign
Medicaid has one very intuitive approach to keeping drug prices in check. Drug companies, under a law called the Medicaid Drug Rebate Program, must rebate Medicaid programs any money that resulted from the increased drug prices outpacing inflation. Inflation is benchmarked to either 1990, or the first year a drug came to market, which ever is later. As an example of how this works, imagine a pharmaceutical company...

DOJ Discusses Its 2020 Healthcare Fraud Enforcement Priorities

Posted  03/6/20
DOJ Headquarters building seen from low angle
In comments at the 2020 FBA Qui Tam conference, the Department of Justice reaffirmed its strong commitment to pursuing fraud under the False Claims Act and emphasized its particular focus on rooting out healthcare fraud. Jody Hunt, Assistant Attorney General in the Civil Division of DOJ, was encouragingly forceful in his comments about the critical role of the FCA in protecting the public fisc—and the patient...
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