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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 50 of 126

June 25, 2020

Georgia-based Piedmont Healthcare, Inc. has agreed to pay $16 million to resolve whistleblower-brought allegations that it violated the Anti-Kickback Statute and False Claims Act.  The relator in this case, a former Piedmont physician, alleged that between 2009 and 2013, Piedmont’s case managers overturned physician recommendations for outpatient care by submitting claims for more expensive inpatient care to Medicare and Medicaid.  Furthermore, when the healthcare system acquired the Atlanta Cardiology Group in 2007, it allegedly paid far above fair market value for a catherization lab that was partly owned by the practice group.  For bringing a successful enforcement action, the unnamed relator will receive a share of nearly $3 million of the settlement proceeds. USAO SDGA

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

June 24, 2020

Augusta University Medical Center (AUMC) has agreed to pay $2.6 million to resolve fraud allegations by the United States, State of Georgia, and State of South Carolina under state and federal False Claims Acts.  According to the government, AUMC knowingly submitted claims to Medicare and Medicaid for a medically unnecessary procedure that was billed as a covered procedure.  USAO SDGA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

Medicare Risk Adjustment Fraud is Not Victimless

Posted  06/18/20
medicare dollars
Implicit in the arguments made by many Medicare Advantage Organizations (MAOs), health plans, hospital networks and other defendants in response to whistleblower and government False Claims Act complaints is that the alleged misconduct—falsifying diagnosis data so that CMS overpays for patients enrolled in an MA plan—involves just a technical record-keeping or administrative dispute with CMS and no actual...

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

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June 16, 2020

A doctor in Mississippi has been sentenced to four years in prison and ordered to pay nearly $5 million in restitution and judgment for committing healthcare fraud against multiple insurers, including TRICARE.  In exchange for a 35% cut of reimbursements, Dr. Shahjahan Sultan had agreed to enter into a contract with a local pharmacy to prescribe expensive compound medications to insured patients, which he did without regard to medical necessity, and which resulted in over $8 million in losses to insurers.  USAO SDMS

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

DOJ Charges Healthcare CEO with Criminal Securities and Healthcare Fraud

Posted  06/12/20
Hands in handcuffs behind back of white man in business suit
In 2008, Rahm Emanuel, then-President Obama’s chief of staff, famously said, “You never want a serious crisis to go to waste.  I mean, it’s an opportunity to do things that you think you could not do before.”  However poorly phrased, generations of political and business leaders have understood the kernel of truth in his admonition. So have scammers and rip-off artists. We have been following the...

Tagged in: Catch of the Week, COVID-19, Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Market Manipulation and Trading Violations, Misrepresentations, Securities Fraud,

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Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders, Write Mary Inman and Max Voldman in RACMonitor

Posted  06/10/20
attorney headshots of Mary Inman and Max Voldman
Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman updated their earlier reporting in RAC Monitor regarding the False Claims Act case brought by Integra Med Analytics against Texas-based hospital chain Baylor Scott & White.  At the end of May, the Fifth Circuit Court of Appeals upheld a Texas district court opinion dismissing the case. As we have earlier written, Integra alleged that the...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Public Disclosure and Public Information, Upcoding, Whistleblower Eligibility,

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Increased Federal Funds, Incentives, and Requirements for Nursing Homes Brings Worrisome Opportunities for Fraud

Posted  06/5/20
wheelchair in the hospital lobby
The pandemic has exposed the razor thin margin for error by which our most vulnerable are cared for in nursing homes. New aggregate federal data reveal the appalling toll on facility residents and staff: over 31,700 deaths as of June 4, 2020 (an undercounted 1/3 of all US COVID-19 deaths), according to the federal government’s Nursing Home Compare.  Responsive federal funding for nursing homes, requirements for...

Tagged in: CC Lawyers, COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud, SNF,

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June 5, 2020

Alaska Neurology Center LLC and its owner, Franklin Ellenson, M.D., have agreed to pay $2 million and enter into a three-year Integrity Agreement to resolve allegations of submitting false claims to federal healthcare programs between 2013 to 2­018.  A whistleblower complaint revealed the defendants had engaged in a bevy of fraudulent billing schemes, including using false dates to bypass caps in reimbursement, billing for services provided by unqualified personnel, billing for non-reimbursable services, using multiple billing codes for procedures covered by a single code, using false names for providers, and resubmitting already rejected claims using false service or diagnosis information.  The whistleblower in this case will receive a relator’s share of $380,000.  USAO AK

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

Financial Pressures on U.S. Hospitals, Combined with New Funding, Increase Risk of Medicare and Medicaid Fraud

Posted  05/22/20
Multistory hospital building set amid trees
Hospitals are an institution we might have expected to be prepared for a healthcare crisis.  It is their job, after all, to provide emergency and intensive healthcare.  In fact, however, the COVID-19 crisis has put enormous pressures on hospitals.  With such new pressures come new risks of healthcare fraud at hospitals.

The Financial Pressures on Hospitals in the COVID-19 Crisis

Against the backdrop of heroic...

Tagged in: COVID-19, FCA Federal, Government Programs Fraud, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers,

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COVID Frauds of the Week: Unproven Tests, Nonexistent Equipment, Price Gouging, and $10 Million in SBA Loans

Posted  05/15/20
sample test tubes scattered around
Fraudsters continue to attempt to capitalize on anxiety and uncertainty during the pandemic by marketing unproven products and services for the prevention, treatment, or cure of COVID-19. This week, we highlight the massive FTC efforts to identify and shut down illegal activities via Warning Letters (around 100 issued to date); two new SEC actions; as well other government actions to quash sales of unproven or...

Tagged in: Catch of the Week, COVID-19, FCA Federal, Financial and Investment Fraud, Healthcare Fraud,

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