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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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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

Tagged in: Healthcare Fraud, Medical Devices and DME,

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...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

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Catch of the Week: New York-Presbyterian Hospital

Posted  01/26/24
Hospital Building Sign
This week's Department of Justice (DOJ) Catch of the Week goes to New York-Presbyterian Hospital.  Yesterday (January 25), the hospital agreed to pay $801,000 to settle charges it violated the False Claims Act by billing Medicare, Medicaid and TRICARE for medically unnecessary images for radiation therapy treatments provided to cancer patients. The settlement is notable not for the relatively small amount of money...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

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January 24, 2024

Johnson & Johnson has agreed to pay $149.5 million to Washington State for its role in fueling the opioid epidemic after the Attorney General Bob Ferguson rejected a 2021 settlement and chose to continue litigation.  The company was a top supplier of ingredients used to make opioid drugs, and marketed the drugs for chronic pain conditions that studies showed were not effectively treated by opioids.  This is the fifth national settlement that Washington State has rejected, and the third so far that has netted the state more than it would have received under the national settlement.  WA AG

Tagged in: Healthcare Fraud,

Silver Lake Hospital and Investors Pay $30 Million to Settle Health Care Case

Posted  01/22/24
Medicare Card
Silver Lake Hospital, operating as Columbus LTACH in Newark, New Jersey, and certain investors recently agreed to pay a combined $30.6 million to settle False Claims Act allegations relating to Medicare payments and violations under the Federal Debt Collection Procedures Act (FDCPA). Silver Lake is a long-term care hospital a whistleblower alleged was claiming excessive "cost outlier" payments from Medicare, a...

Tagged in: FCA Federal, Healthcare Fraud, Medicare,

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January 16, 2024

Silver Lake Hospital, a long-term care hospital in New Jersey, will pay $18.6 million, and its principal investors Dr. Richard Lipsky and Columbus Management South LLC will pay another $12 million, to resolve allegations of violating the False Claims Act and Federal Debt Collection Procedures Act (FDCPA).  The hospital allegedly claimed excessive cost outlier payments from Medicare, well in excess of its needs or ability to repay, and transferred millions of dollars to investors without receiving equivalent value in return.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud,

Testing Lab and Owner/CEO Settle False Claims Act Case for $13.25 Million

Posted  01/12/24
Laboratory Analysis. Scientist Measuring Sample
RDx Bioscience Inc. (“RDx”), a clinical laboratory that operated in New Jersey, and its owner and CEO agreed to pay $13.25 million to settle a False Claims Act case alleging kickbacks and unnecessary testing schemes, according to a recent DOJ press release.  The press release also notes that RDx and its owner/CEO agreed to cooperate with the DOJ’s “investigations of, and litigation against, other participants...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity,

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Top Ten False Claims Act Recoveries in 2023

Posted  01/11/24
It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

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January 10, 2024

Clinical laboratory RDx Bioscience Inc. and its owner and CEO Eric Leykin have agreed to pay over $10 million to the federal government and about $3 million to the State of New Jersey for violating the Anti-Kickback Statute and federal and state False Claims Acts.  From 2018 to 2022, RDx and Leykin were allegedly involved with five types of kickback schemes in order to induce referrals to RDx for laboratory testing, then submitted or caused false claims to be submitted to Medicare and Medicaid that were unnecessary or uncovered.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare,

Private Equity Firms Buying Healthcare Companies May Increase Risks to Patients and Lead to More Whistleblower Actions

Posted  01/8/24
Businessman Under Dark Shadow Pointing Finger
Private equity (PE) firms are in the hot seat, particularly when it comes to acquiring and investing in healthcare companies.  According to a recent CNN article, a research study published in JAMA found that “[h]ealth care became more hazardous for patients at hospitals purchased by private equity firms.”  This not only should concern patients and Government enforcers.  It also could be a harbinger of more...

Tagged in: Healthcare Antitrust, Healthcare Fraud, Whistleblower Eligibility,

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