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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 78 of 126

Top Ten State Fraud Recoveries of 2018

Posted  01/25/19
Political map of continental United States with states outlined
While 2018 saw many important federal settlements and whistleblower awards across a wide range of industries, state governments were equally busy rooting out fraud. In fact, in the last few years, recognizing the ever-growing need to hold businesses accountable for defrauding taxpayers, several states have passed their own false claims statutes modeled after the federal false claims act. These laws operate in a...

Tagged in: Financial and Investment Fraud, Healthcare Fraud, Top 10,

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Top Ten Healthcare Recoveries of 2018

Posted  01/15/19
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2018 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Here are the top ten healthcare recoveries of 2018 by the numbers:
    1. Amerisource Bergen Corporation - In...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Managed Care, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud, Risk Adjustment Fraud, Top 10,

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Sharp HealthCare - Healthcare Fraud/Kickbacks (Undisclosed)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Sharp HealthCare Center for Research, Sharp’s clinical-trial research arm, paid kickbacks to entice prospective trial sponsors to host clinical trials at Sharp.  In November 2019, the company agreed to pay an undisclosed amount to settle the matter.  Our client received a whistleblower award of an undisclosed portion of the government's recovery.  Read more -- CC.

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Whistleblower Rewards,

Top Ten Financial and Healthcare Fraud Prison Sentences of 2018

Posted  01/11/19
Hands gripping prison bars
Financial and healthcare fraud schemes can result not just in civil investigations and liability, but also in prison time for the individuals involved.  In 2018, the Department of Justice obtained substantial prison sentences in numerous cases involving healthcare and financial frauds, helping to bring justice to the patients, investors, or individuals harmed by criminal fraudsters.  Many of the fraudulent schemes...

Tagged in: Criminal Proceedings, Financial and Investment Fraud, Healthcare Fraud, Securities Fraud, Top 10,

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Healthcare Whistleblowers Continue as Backbone of DOJ Recoveries: A Look at DOJ’s 2018 Fraud and FCA Statistics

Posted  01/2/19
Department of Justice
The Department of Justice released its annual report of DOJ recoveries for fraud and false claims against the U.S., showing recoveries of $2.8 billion in settlements and judgments for the fiscal year ending September 2018. Once again, recoveries for healthcare fraud accounted for the majority of funds recovered: of the $2.8 billion recovered, $2.5 billion was attributed to healthcare fraud. And, once again,

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Statistics,

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December 21, 2018

The United States has partially intervened in a False Claims Act case initiated by a whistleblower against Wheeling Hospital Inc. along with Wheeling's management consultant R & V Associates Ltd., and Wheeling's CEO, Ronald Violi.  The defendants are alleged to have violated the Stark Law and Anti-Kickback Statute including through its payments to physicians based on referrals by those physicians and/or in excess of fair market value.  The whistleblower, Louis Longo, was previously Wheeling's executive vice president.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Hospital Fraud, Whistleblower Case,

December 20, 2018

Pain specialist Dr. Jonathan Daitch, a principal in Ft. Myers-based Advanced Pain Management Specialists, P.A., has agreed to pay more than $1.7 million to resolve allegations that he violated the False Claims Act.  Dr. Daitch caused Medicare and Tricare to be billed for medically-unnecessary urine drug testing performed at Advanced Pain's in-house laboratory.  In addition, Daitch received kickbacks for anesthesia services.  A co-owner of Advanced Pain, Dr. Michael Frey, previously agreed to pay $2.8 million to settle similar claims.  USAO MD Fla

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

December 19, 2018

A vascular surgeon and his practice group, Dr. Irfan Siddiqui and the Heart and Vascular Institute of Florida (HAVI), have agreed to pay $2.23 million to settle a False Claims Act brought by a whistleblower, Lois Hawks, who had been a patient of the doctor.  Defendants were alleged to have submitted false claims for vein ablation services that were not medically necessary, were performed by unqualified personnel, or were based on medical records containing false diagnoses and symptoms.  In addition, defendants were alleged to have upcoded evaluation and management service claims.  Ms. Haws will receive a relator's share of $446,000.  USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

December 18, 2018

Following an earlier settlement of federal claims, Florida has announced that hospital chain Health Management Associates, LLC, will pay $5.5 million to Florida to resolve claims that two HMA hospitals, Charlotte Regional Medical Center and Peace River Medical Center, billed the Florida Medicaid program for services referred by physicians to whom HMA provided remuneration in return for patient referrals.  The unlawful remuneration took the form of free rent, office space, and staff services, as well as direct payments purportedly meant to cover overhead and administrative costs.  FL AG

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid,

December 18, 2018

After submitting more than $3.5 million in false Medicare claims for home health services, John Dubor of Sugar Land, Texas, has been sentenced to nine years in prison and ordered to pay $3.5 million in restitution.  Through his company, Care Committers Health Services, Dubor paid marketers and group home owners for Medicare beneficiary information, then falsely billed Medicare and Medicaid for home health services for which the beneficiaries did not qualify, did not receive, or both.  Dubor himself would falsify patient assessment forms to make patients appear sicker, entitling him to higher reimbursement rates, and instructed his employees to falsify certifications and forge physician signatures.  USAO SDTX

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

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