Healthcare Fraud
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November 16th, 2017
New York announced the arrests of unlicensed plastic surgeon Brad Jacobs, 56, of Westbury, NY, and licensed physician Nicholas Sewell, 74, of Jackson Heights, NY, on charges they engaged in a four-year scheme to illegally perform plastic surgeries on over 60 patients, including causing permanent disfigurement to one patient. Jacobs, a former plastic surgeon, surrendered his New York medical license in 2007 after the New York State Department of Health charged him with 29 specifications of Professional Medical Misconduct. From September 2012 to June 2016, Jacobs and Sewell allegedly defrauded patients undergoing costly cosmetic surgery procedures – each averaging between $8,000 and $10,000 – by falsely representing that Jacobs was authorized to practice medicine. NYNovember 15th, 2017
New York announced the sentencings of Kenneth Cohn, Sharon Cohn, and Yellow Medi-Van and Taxi, Inc., for stealing hundreds of thousands of dollars in Medicaid funds and knowingly operating transportation services without Worker’s Compensation insurance. At sentencing in Broome County Court, the Cohns forfeited and released $455,604 currently being withheld by the New York State Department of Health, to the Attorney General’s Medicaid Fraud Control Unit. Each defendant also agreed to pay $50,000 in restitution, for a total of $100,000. Kenneth Cohn was sentenced to five years’ probation, and Sharon Cohn was sentenced to one year conditional discharge. Yellow Medi-Van and Taxi, Inc. was sentenced to three years conditional discharge. NYOctober 16, 2017
Louisiana announced the arrests of three New Orleans women as a result of an investigation exposing over $2 million in Medicaid Fraud. Lanice Stamps, 44 of New Orleans and owner of A New Direction Support Services, was arrested on 10 counts of Medicaid fraud for allegedly providing false and fraudulent claims for behavioral health services not rendered. Many recipients were fraudulently diagnosed as moderately mentally retarded or severely autistic so that the claims submitted could be billed at a higher level and they had never received counseling services. LAFreedom Health/Optimum - Healthcare Fraud/Medicare Advantage ($32.5 million)
Constantine Cannon represented a whistleblower in a False Claims Act case alleging Freedom Health and Optimum Healthcare inflated their Medicare Advantage patient risk scores to secure artificially high Medicare reimbursement. In May 2017, the companies agreed to pay $32.5 million to settle the matter. Our client received a whistleblower award of roughly $6.4 million. Read more -- NPR, Miami Herald, DOJ, CC.Health Insurers May Be Contributing to the Opioid Crisis in the United States
Posted 09/18/17
By the C|C Whistleblower Lawyer Team
An article in the New York Times describes the role health insurers may be playing in perpetuating the opioid crisis in the United States. The argument is that health insurers are limiting access to pain medications that have a lower risk of dependency. The reason is that opioid drugs are generally cheaper and less risky alternatives are more expensive. The New York State...
Two Bay Area Companies for Developmentally Disabled Settle Whistleblower Charges of Overbilling
Posted 08/29/17
By the C|C Whistleblower Lawyer Team
Two Bay Area companies and their owners agreed to pay roughly $2 million to settle charges they violated the False Claims Act by overbilling the government in a program designed to serve Californians with developmental disabilities. The government, and the whistleblower who originated the action -- Beverly McCaffery -- alleged that Alternative Learning Center, its president...
August 18, 2017
Illinois and other states announced a $465 million settlement between the federal government and states with Mylan Inc. and its wholly-owned subsidiary, Mylan Specialty L.P. (Mylan), to resolve allegations that Mylan knowingly underpaid rebates owed to the Medicaid program for EpiPen® and EpiPen Jr.® (EpiPen) dispensed to Medicaid beneficiaries. The settlement resolves allegations that from July 29, 2010 to March 31, 2017, Mylan submitted false statements to the Centers for Medicare and Medicaid Services (CMS) that incorrectly classified EpiPens under terms defined in the Rebate Statute and Rebate Agreement. Mylan also failed to report a "Best Price" to CMS for EpiPens, as directed by the same statute. As a result, Mylan submitted false statements related to EpiPens to CMS and the states for Medicaid rebate purposes and underpaid EpiPen rebates to the state Medicaid programs. IL, IARehab Clinics Allegedly Paying Kickbacks to “Body Brokers”
Posted 08/17/17
By the C|C Whistleblower Lawyer Team
With the rise of the nation’s opioid crises, more opportunities for corruption and fraud have developed. An industry of patient brokering or “body brokering” has been born. Body brokers are paid kickbacks by rehab clinics in exchange for their recruiting of patients. Patients with good insurance are the most appealing recruits.
Kickbacks are also being paid between...