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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Catch of the Week - Endo Health Solutions

Posted  03/1/24
spilt pills
This week's Department of Justice (DOJ) Catch of the Week goes to Endo Health Solutions.  Yesterday (February 29), the now-bankrupt pharmaceutical company agreed to pay up to $465 million over 10 years to settle criminal and civil charges relating to its sales and marketing of the opioid drug Opana.  Endo voluntarily withdrew the drug from the market in 2017. This bankruptcy-negotiated payout flows from a...

DOJ Releases False Claims Act Results for 2023

Posted  03/1/24
Department of Justice Seal Logo
The Department of Justice (DOJ) just released its False Claims Act results for 2023.  By all accounts, it was another big year for the government's primary fraud-fighting tool.  The top-line numbers are roughly $2.7 billion in total recoveries from 543 settlements and judgments, the highest number of settlements and judgments in a single year.  This brings the total tally of False Claims Act recoveries to more than...

DOJ Principal Deputy Assistant Attorney General Credits Whistleblowers, Identifies 2024 Priorities

Posted  02/27/24
Department of Justice Seal Logo
DOJ Principal Deputy Assistant Attorney General Brian Boynton recently spoke at the 2024 Federal Bar Association’s Qui Tam Conference.  Here are a few key takeaways from his remarks, which can be found here.
  1. Crediting Whistleblowers. Boynton lauded whistleblowers, calling them “a critical source of [DOJ’s] enforcement efforts,” and he thanked them and their counsel for their efforts, adding that the DOJ...

New York Doctor Indicted for $20.7 Million in Medicare Fraud and Kickback Scheme

Posted  02/23/24
doctor with dollars

On February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and illegal kickback scheme. According to the DOJ press release, this scheme involved the submission of over $20.7 million in false and fraudulent claims to Medicare, primarily for medically unnecessary genetic cancer screening and Covid-19...

Catch of the Week: Lincare, Inc.

Posted  02/16/24
DOJ website magnified logo
This week's Department of Justice (DOJ) Catch of the Week goes to Lincare, Inc., a durable medical equipment supplier with locations throughout the country.  Yesterday (February 15), the company agreed to pay $25.5 million to settle DOJ charges of violating the False Claims Act by billing Medicare for the rental of non-invasive ventilators (NIVs) when patients no longer needed or used them.  DOJ also charged Lincare...

February 1, 2024

One of the nation’s largest healthcare systems, Providence, has agreed to forgive more than $137 million in medical debt and refund more than $20 million to patients following a lawsuit by Washington State.  According to the Attorney General’s Office, between 2018 and 2023, Providence trained staff to demand payments from low income patients who were eligible for financial assistance, then sent some of those same patients to debt collectors even if they were Medicaid beneficiaries.  Almost 99,500 patients will receive relief as a result of this settlement, with the average refund amounting to about $478.  WA AG

February 1, 2024

Marketing firm Publicis Health, which was agency of record for all of Purdue Pharma’s branded opioid drugs as well as for other opioid manufacturers, has agreed to a $350 million national settlement for helping to fuel the prescription opioid crisis.  A government investigation found that the multinational company farmed data from recordings of conversations between patients and providers and used that data to develop Purdue’s sales tactics.  As part of this settlement, Publicis has also agreed to disclose thousands of internal documents detailing its work for opioid companies, such as Purdue, on a public website.  CA AG; NC AG; PA AG

February 1, 2024

Hikma Pharmaceauticals has reached a settlement in principle with multiple states for $150 million following allegations that the opioid manufacturer failed to monitor and report suspicious orders.  From the settlement proceeds, $115 million will be paid in cash, while the remaining $35 million will be allocated toward opioid addiction treatment medications.  CA AG; NC AG; VA AG

January 31, 2024

In the fourth-largest Controlled Substances Act (CSA) settlement in history, e-commerce company eBay has agreed to pay $59 million for its failure to properly regulate the sales of pill presses and encapsulating machines on its website.  Such devices can be used to produce pills that mimic pills produced by legitimate pharmaceutical companies.  To combat this, the CSA requires that purchasers of such devices have their identities verified, recorded, and reported to the DEA; however, eBay failed to do so.  DOJ

Top Ten Healthcare False Claims Act Recoveries for 2023

Posted  01/30/24
Doctor Holding Stethoscope with Crossed Arms
This past year was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool.  And as we noted in our recent Top Ten listing of False Claims Act recoveries for 2023, all but 3 of the Top Ten recoveries were in the healthcare space involving various schemes to defraud Medicare and Medicaid.  So here is our look at the Top Ten healthcare recoveries for...
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