Healthcare Fraud
This archive displays posts tagged as relevant to healthcare fraud.
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December 21, 2023
Ultragenyx Pharmaceutical, Inc., maker of Crysvita, will pay $6 million for violating the False Claims Act. Crysvita is prescribed to treat a rare inherited blood disorder, which may require a genetic test to definitively diagnose. To induce purchases and referrals, Ultragenyx paid a laboratory to conduct genetic tests at no cost to healthcare providers or patients, and then provide the results reports to Ultragenyx. Ultragenyx then used the positive test results reports to target healthcare providers for Crysvita sales. Internally, Ultragenyx referred to this kickback scheme as their "sponsored" testing program. The program was exposed via a qui tam whistleblower, who will receive $1.07 million of the $6.7 million recovery. DOJDecember 21, 2023
Armando Herrera was sentenced to 51 months in prison for distributing at least $16.7 million worth of adulterated and misbranded prescription HIV drugs. Herrera and his co-conspirators operated companies in four states, creating false documentation to then pass off the drugs as legitimately acquired, and then sold to unwitting pharmaceutical suppliers who, in turn, sold them to unsuspecting HIV patients. DOJDecember 19, 2023
Indiana-based Community Health Network Inc. has agreed to pay $345 million to resolve claims by its former CFO and COO Thomas Fischer, which alleged the healthcare system submitted claims to Medicare that were tainted by violations of the Stark Law. In order to capture physicians’ downstream referrals, Community paid physicians salaries that were sometimes double market rate, and awarded them bonuses based on the number of referrals. Community then submitted claims resulting from these referrals for reimbursement. DOJDecember 18, 2023
Heart monitoring device manufacturer BioTelemetry Inc. and its subsidiary, LifeWatch Services Inc., have agreed to pay more than $14.7 million for causing false claims to be submitted to federal healthcare programs. The claims were brought in two separate qui tam suits, one by an employee of one of LifeWatch’s customers, Michael Pelletier, and the other by SFP I LLC. The whistleblowers alleged that the companies knew the design of their enrollment portal would steer clinical staff into enrolling patients in telemetry, which is reimbursed at a higher rate, rather than holter monitoring and event monitoring, which is reimbursed at a lower rate. DOJCaught in the Crosshairs - Loyal Source Government Services
Posted 12/1/23
OIG Identifies Fraud as Top Challenge in 2023 HHS Annual Report - Bring on the Whistleblowers
Posted 11/21/23
November 20, 2023
Hospital chain PeaceHealth, which operates in Washington State, has been ordered to refund more than 15,000 low-income patients up to $13.4 million after the Washington Attorney General’s Office found it billed patients without notifying them of their eligibility to obtain financial assistance. PeaceHealth must also pay $2 million to the Attorney General’s Office to reimburse the cost of the government’s investigation. WA AG$45.6 Million Settlement in False Claims Act Case Against Nursing Facility Defendants
Posted 11/17/23
