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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 64 of 126

Fraud in Government Telehealth Programs: How to Report it Under the False Claims Act for a Whistleblower Reward

Posted  09/4/19
When patients are unable to see a doctor in person, technology can offer solutions. Telehealth or telemedicine is the provision of health services – including assessment, diagnosis, intervention, consultation, or supervision – across distance through the use of information technology. It can be especially valuable in rural areas, where specialty providers may not be available. And its use has grown...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Provider Fraud, Whistleblower Eligibility,

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September 4, 2019

Pharmaceutical company Mallinckrodt ARD LLC has agreed to pay $15.4 million to settle allegations of violating the Anti-Kickback Statute by “wining and dining” healthcare providers to induce Medicare prescriptions of its drug H.P. Acthar Gel.  The allegations arose from two whistleblowers, who will jointly receive about $2.9 million of the settlement.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

August 29, 2019

International SOS Assistance, Inc. and related entities and individuals have agreed to pay $940,000 to resolve claims that they overbilled TRICARE for air medical evacuation services provided to military service members and their families.  International SOS was alleged to have negotiated discounts from third-party air ambulance services, but failed to pass those discounts on to TRICARE.  The case was brought by a whistleblower who used to be a flight desk manager for International SOS; he will receive an award of $165,000.  USAO EDPA

Tagged in: Ambulance, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Other Government Health Programs, Pricing Fraud, Whistleblower Case, Whistleblower Rewards,

Question of the Week — Is the use of public nuisance law against J&J for its role in the opioid crisis appropriate?

Posted  08/29/19
The landmark $572M opioid verdict in Oklahoma against Johnson & Johnson stemmed from a single claim: “public nuisance” under state law.  Other cases against opioid manufacturers, including whistleblower cases, involve claims for fraud, unlawful marketing, improper prescriptions, kickbacks, violating the Controlled Substances Act by failing to report suspicious purchases, and even flooding the black market.  But...

Tagged in: Defendants, Healthcare Fraud, Importance of Whistleblowers, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week, Whistleblower Case,

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August 29, 2019

A healthcare executive in Tennessee has been sentenced to 3.5 years in prison and ordered to forfeit nearly $600,000 for her role in a $4.6 million illegal kickback scheme.  In pleading guilty to violating the Anti-Kickback Statute, Brenda Montgomery admitted that she paid the CEO of Comprehensive Pain Specialist (CPS), John Davis, a 60% cut of Medicare reimbursements—amounting to more than $770,000—for arranging the referrals of durable medical equipment.  As a result of the scheme, Montgomery herself received fraudulent reimbursements amounting to as much as $2.9 million.  USAO MDTN

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medical Devices and DME, Medicare,

August 27, 2019

Three doctors and a cardiac center have agreed to pay a combined $1.1 million to resolve allegations of receiving kickbacks from the now defunct Northwest Medical Testing Company (NMTC) in exchange for ordering genetic tests from NMTC that were then billed to Medicare.  Dr. Gregory Sampognaro will pay $519,750, Dr. Isabella Strickland will pay $107,900, Dr. Warren Strickland will pay $95,053, and Cardiology P.C. will pay $411,300.  USAO WDWA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Medicare,

August 16, 2019

2d Chance PLLC, a Kentucky-based substance abuse center, will pay $200,494 to resolve allegations under the False Claims Act that it entered into an arrangement with Compliance Advantage, LLC, a toxicology lab, whereby 2d Chance referred patients to Compliance Advantage for complex drug testing, and Compliance Advantage provided a no-cost chemistry analyzer to 2d Chance, allowing 2d Chance to perform some urine testing at its site and bill Medicaid for those services.  The financial arrangement violated the Anti-Kickback Statute.  EDKY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

August 16, 2019

Kentucky-based Ultimate Care Medical Services, LLC, doing business as Ultimate Treatment Center, and its principal, Dr. Rose O. Uradu, have agreed to pay $1.4 million to resolve allegations that they submitted false claims to Mediare and Kentucky's Medicaid program for services that were not provided.  Defendants billed for "evaluation & management" services when patients visited the clinic to receive methadone, visits which did not include a medical examination, which is required to bill for evaluation &  management.  In addition, defendants billed for complex urine drug testing when they lacked the equipment to perform such testing, and issued buprenorphine prescriptions at an rate greater than authorized.  USAO ED KY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million.  According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals.  As part of the settlement, Seddon will receive a $200,000 relator’s share.  USAO SDAL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 15, 2019

North Carolina ambulance company Gate City Transportation has been ordered to pay $5.25 million in restitution for falsely billing the state's Medicaid program for convalescent ambulance services when, in fact, the company was providing only medical van service to ambulatory and wheelchair-bound patients.  During the investigation, agents confiscated more than $5 million in cash and property, which will be applied to the restitution.  USAO MD NC

Tagged in: Ambulance, Criminal Proceedings, Healthcare Fraud, Medicaid,

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