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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 103 of 108

March 9, 2015

Two former employees of the Mental Health Association of Rockland County, Inc. will receive an undisclosed whistleblower award from the $304,000 settlement resolving allegations MHAR violated the New York False Claims Act through its managers and employees altering records in advance of a Medicaid audit so the records would appear to support claims MHAR submitted to New York State's Medicaid program.   NY

Seventh Circuit Gives Broad Read To What Constitutes A "Referral" Under Anti-Kickback Statute

Posted  02/26/15
By Gordon Schnell
Healthcare Fraud
Under the Anti-Kickback Statute, physicians may not solicit or receive kickbacks for referring Medicare patients to a particular healthcare provider. The question before the Seventh Circuit in United States v. Patel was the scope of what constitutes a referral under the statute. According to the Court, the scope is quite broad, even extending to situations where the physician plays no role in selecting the healthcare...

February 23, 2015

The FTC has challenged marketers of “melanoma detection” apps, MelApp and Mole Detective, for deceptively claiming their mobile apps could detect symptoms of melanoma, even in its early stages, without scientific evidence to back up its claims. FTC

February 6, 2015

Minnesota-based medical device manufacturer Medtronic Inc. agreed to pay $2.8M to resolve allegations it violated the False Claims Act by causing physicians to submit false claims to federal health care programs for investigational medical procedures known as “SubQ stimulations” that were not reimbursable. According to the government, Medtronic improperly promoted the procedure and the use of its spinal cord stimulation devices for the procedure even though its safety and efficacy had not been established by the FDA. The charges were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Medtronic sales representative Jason Nickell. He will receive a whistleblower award of $602,000. DOJ

January 22, 2015

Pennsylvania Attorney General Kathleen G. Kane announced the arrest of Claire Risoldi of Bucks County and four members of her family who allegedly conspired to defraud insurance companies in excess of $20M to live an “excessively extravagant lifestyle.” PA

January 20, 2015

Massachusetts Attorney General Martha Coakley announced South Shore Physician Hospital Organization will pay $1.77M to settle allegations of operating a recruitment grant program through which it paid kickbacks to its physician members in exchange for patient referrals. MA

January 20, 2015

Florida Attorney General Pam Bondi’s Medicaid Fraud Control Unit arrested six former Targeted Case Managers of DS Connections, Inc. for more than $170,000 in Medicaid fraud. FL

January 12, 2015

New York Attorney General Eric T. Schneiderman announced an agreement with Excellus Health Plan, Inc. requiring that its contracted health care providers issue refunds to thousands of members in New York State for charging excessive copays. The investigation began when an Excellus member complained to the Attorney General’s Health Care Bureau Helpline that his provider billed him a specialty care co-payment of $25 after visiting his primary care physician to whom he had already paid the primary care co-payment of $15. NY

January 7, 2015

Florida Attorney General Pam Bondi announced that Florida, along with California, Colorado, Kentucky, and Ohio and the federal government, entered a $22 million national settlement with DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the US. The settlement resolves allegations originating in a whistleblower lawsuit that DaVita paid illegal kickbacks to induce the referral of patients to its dialysis clinics, causing false claims to be submitted to the Medicaid program. DaVita will pay Florida $5.6 million in restitution and other recoveries. FL

DaVita — Medicare Fraud/Kickbacks ($400 million)

Two of our whistleblower attorneys led the representation of David Barbetta, a former financial analyst for DaVita HealthCare Partners, one of the largest providers of dialysis services in the United States. Mr. Barbetta brought a qui tam action under the False Claims Act against DaVita alleging the company violated the Anti-Kickback Statute by paying physicians to refer their patients to DaVita clinics for dialysis. According to the complaint, DaVita sold doctors shares of DaVita clinics at below fair market value, and purchased doctors’ interests in other clinics at above fair market value. The government joined the case, and alleged that DaVita had entered into these sweetheart deals with doctors, which gave the doctors returns of over 100%, and the doctors then steered their patients to DaVita clinics. In 2014, DaVita paid $400 million to settle the case, the largest stand-alone kickback settlement to date. See Denver Post and Modern Healthcare for more.
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