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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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March 3, 2023

Florida-based Lakeland Regional Medical Center (“LRMC”) has agreed to pay $4 million to resolve False Claims allegations of making improper non-bona fide donations to Florida’s Polk County in order to free up funds and increase the center’s reimbursements from Medicaid.  The donations involved paying off some of the county’s financial obligations to other healthcare providers, so the reimbursements that LRMC received were effectively funded by their own donations.  DOJ

Healthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks

Posted  03/13/23
Very few cases ever filed reach jury trial. The vast majority are dismissed or settle long before that stage. This trend is particularly true for cases filed under the False Claims Act (FCA), where defendants face treble damages and penalties if they are found liable at trial.  In FCA trials where the Government and/or whistleblower prevails, the judge, unbeknownst to the jury, is required to triple the amount of...

February 27, 2023

Several individuals and entities involved with the Saratoga Center for Rehabilitation and Skilled Nursing Care have agreed to pay over $7.1 million to resolve allegations of violating the False Claims Act by submitting claims for essentially worthless services.  From 2017 until the center closed in 2021, while receiving reimbursements from New York’s Medicaid program, the center’s owners and operators failed to provide adequate staffing, hot water, and clean linens, and failed to dispose of solid waste.  As a result of these failures, conditions fell below regulatory standards, and residents suffered from unnecessary errors and neglect.  NY AG; DOJ

February 27, 2023

The University of Pittsburgh Medical Center (“UPMC”), University of Pittsburgh Physicians (“UPP”), and Dr. James Luketich have agreed to pay $8.5 million to settle a False Claims Act suit launched by a former UPMC surgeon, Dr. Jonathan D’Cunha.  According to the qui tam suit, which was joined by the government, Dr. Luketich regularly billed Medicare for concurrently performed complex cardiothoracic surgeries, often as many as three at a time, in violation of statutes and regulations.  The practice increased the risk of surgical complications to patients, as it meant the physician was not present for key portions of the surgeries, and patients were under anesthesia for longer than necessary.  USAO WDPA

February 13, 2023

Spacelabs Healthcare, LLC has agreed to pay $2.5 million to settle claims of violating the False Claims Act by overcharging the Department of Veteran Affairs and Department of Defense between 2014 and 2019.  According to a qui tam suit filed by two former Spacelabs employees, Marci Gebhardt and Christopher Kelley, the company agreed to contract clauses in which they would sell patient monitoring equipment to the government at lower rates.  However, Spacelabs then failed to comply when billing the VA and Defense Logistics Agency.  For their role in bringing a successful enforcement action, Gebhardt and Kelley will share in a $437,500 reward.  DOJ

February 8, 2023

Centene Corporation has agreed to pay $215 million to resolve allegations of violating the California False Claims Act.  A government investigation revealed that for almost two years, Centene failed to disclose or pass on discounted prescription drug costs to the state’s Medicaid program, as mandated by program rules, and instead falsely reported higher costs incurred by two of its managed care plans, which together serve beneficiaries in over 20 counties.  CA AG

DOJ FY2022 Annual Fraud Report Shows $2.2 Billion in Total Recoveries, with $1.9 Billion Thanks to Whistleblowers - But There are Reasons for Concern

Posted  02/8/23
DOJ Headquarters building seen from low angle
The Department of Justice released its annual report of civil recoveries for fraud and false claims against the U.S., showing $2.2 billion in settlements and judgments for the fiscal year ending September 2022. The data released by DOJ show the critical role that whistleblowers play in securing these recoveries for the government:  of the $2.2 billion recovered, $1.96 billion – 89% – was recovered in cases...

February 7, 2023

A startup that operates as an online pharmacy for birth control and contraceptives has agreed to pay $15 million to settle whistleblower claims of defrauding California’s Medicaid program of millions of dollars.  In violation of the state False Claims Act, The Pill Club allegedly billed for ineligible services, services not rendered, and enormous quantities of expensive products not ordered by customers.  Investigators found that even in cases where customers asked to stop receiving those products, the company continued to dispense enormous quantities and bill the government for them.  CA AG

February 7, 2023

United Energy Workers Healthcare, Corp., which provides home health services in multiple states, has paid $9 million to resolve allegations of submitting false claims to the U.S. Department of Labor on behalf of beneficiaries of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).  Multiple whistleblowers alleged that between 2013 and 2021, the defendant and related entities billed for services that were either not covered under EEOICPA program rules, not medically necessary, not provided by appropriately licensed individuals, or not provided entirely.  USAO SDOH

February 2, 2023

Central California medical provider Clinica Sierra Vista (CSV) has agreed to pay nearly $26 million to settle claims of violating the state False Claims Act.  Following an internal investigation, the company’s new management voluntarily disclosed to the government that former executives knowingly submitted false information on financial reports in order to receive higher payments from the state’s Medicaid program.  CA AG
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