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Managed Care

This archive displays posts tagged as relevant to managed care and fraud in managed care programs and services. You may also be interested in our pages:

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Constantine Cannon Partner Jessica Moore on Court’s Decision in Medicare Advantage Case

Posted  07/23/18
Becker’s Hospital Review published Four Key Takeaways From 9th Circuit’s Resurrection of the Silingo Medicare Advantage Case, written by Constantine Cannon partner Jessica T. Moore. In the article, Ms. Moore analyzes the Ninth Circuit’s July, 2018, ruling in U.S. ex rel. Silingo v. WellPoint, Inc., a case brought by a whistleblower under the False Claims Act alleging risk adjustment fraud in Medicare’s Part C...

4 Key takeaways from 9th Circuit’s Resurrection of the Silingo Medicare Advantage Case

Posted  07/20/18
Whistleblower attorney Jessica Moore published in Becker's Hospital Review (July 20, 2018).  Click here to read the article.

March 28, 2018

CenterLight Healthcare, Inc. agreed to pay $10 million to settle claims of violating the False Claims Act for collecting monthly Medicaid payments for 186 adult home residents who frequently did not receive required services while enrolled in Centerlight’s managed long-term care plan. In connection with the filing of the lawsuit and settlement, the Government had previously joined and settled a private whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. In that case, Centerlight agreed to pay $46.7 million to settle claims of violating the False Claims Act by using social adult day care centers to enroll ineligible members in Centerlight’s managed long-term care plan. DOJ (SDNY)

November 22, 2017

Thaddeus M.S. Bereday, the former general counsel of WellCare Health Plans Inc., a company that operates health maintenance organizations in several states, was sentenced to six months in prison for his role in a $35 million health care fraud scheme.  Specifically, Bereday and others were charged with submitting inflated expenditure information in the WellCare's annual reports to Florida Medicaid in order to reduce the WellCare HMOs’ contractual payback obligations for behavioral health care services.  DOJ

August 7, 2017

Mary Inman appeared as a special guest on RAC Monitor's "Monitor Monday" radio broadcast Whistleblowers Allege the Suppression of Complaints at United Healthcare to talk about the recent unsealing of a whistleblower lawsuit accusing United Health Services, Inc. of hiding patients’ complaints of misconduct in order to improperly boost its Star ratings and receive undeserved performance bonuses from CMS.

Medicare Advantage May be Less than Ideal Solution for our Sickest Seniors

Posted  07/6/17
By the C|C Whistleblower Lawyer Team As of 2017, a third (approximately 19 million) of all Medicare beneficiaries are now in the Medicare Advantage (MA) program, which is run by private insurers. The insurers receive payments from the federal government based on the sickliness of the population the plan insures, populations with more incidents of severe or chronic diseases lead to higher reimbursements. Insurers...

In the Crosshairs: Medicare Advantage and Risk Adjustment Fraud

Posted  06/13/17
By the C|C Whistleblower Lawyer Team Listen to RAC Monitor's broadcast program, "In the Crosshairs: Medicare Advantage and Risk Adjustment Fraud," featuring Constantine Cannon Partner, Mary Inman. Ms. Inman also discusses Constantine Cannon’s recent $32.5 million settlement of the whistleblower case against Freedom Health, Optimum Healthcare, and Sidd Pagidipati involving allegations of risk adjustment fraud (at...

May 30, 2017

Florida-based managed care service provider Freedom Health Inc. agreed to pay roughly $32 million to settle charges it violated the False Claims Act by engaging in illegal schemes to maximize its Medicare Advantage plan payments from the government.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Freedom Health employee and Constantine Cannon client Darren D. Sewell.  He will receive a yet-to-be-determine whistleblower award from the proceeds of the government's recovery.  Whistleblower Insider

June 7, 2017

New York announced that Kester Atumonyogo, of Valley Stream, NY, and his company Monack Medical Supply, Inc. were arraigned on an indictment charging Atumonyogo and Monack with billing Medicaid and Healthfirst, a Medicaid managed care organization, for an expensive nutritional formula while supplying patients with a lower-priced substitute and stealing over $1 million in the process. Atumonyogo, 49, was arraigned in New York Supreme Court, Kings County, by the Honorable Danny K. Chun. According to the indictment, Atumonyogo used a fraudulent social security number to enroll Monack as a Medicaid-participating provider of medical supplies. The company then allegedly filed false claims to Medicaid and Healthfirst that Monack had dispensed to pediatric patients a highly specialized and expensive enteral nutritional formula, which is prescribed by physicians for patients who must obtain nutrients via a feeding tube and cannot metabolize dietary nutrients from substantive food. NY
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