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Medicaid

This archive displays posts tagged as relevant to Medicaid and fraud in the Medicaid program. You may also be interested in our pages:

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February 28, 2024

The owner and operator of a clinical laboratory in Georgia has pleaded guilty and agreed to pay $14.3 million to resolve charges of paying illegal kickbacks and causing false claims to be submitted to Georgia’s Medicaid program.  According to Capstone Diagnostics’ former laboratory manager, Andrew Maloney directed Capstone to pay volume-based commissions to independent sales representatives in exchange for them arranging medically unnecessary urine drug tests and respiratory pathogen panels to come their way.  The laboratory ultimately submitted over $1 million in tainted claims to Georgia Medicaid.  For bringing a successful case under the False Claims Act, whistleblower Jesse Allen will receive almost $3 million.  DOJ

Catch of the Week: Lincare, Inc.

Posted  02/16/24
DOJ website magnified logo
This week's Department of Justice (DOJ) Catch of the Week goes to Lincare, Inc., a durable medical equipment supplier with locations throughout the country.  Yesterday (February 15), the company agreed to pay $25.5 million to settle DOJ charges of violating the False Claims Act by billing Medicare for the rental of non-invasive ventilators (NIVs) when patients no longer needed or used them.  DOJ also charged Lincare...

Top Ten Healthcare False Claims Act Recoveries for 2023

Posted  01/30/24
Doctor Holding Stethoscope with Crossed Arms
This past year was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool.  And as we noted in our recent Top Ten listing of False Claims Act recoveries for 2023, all but 3 of the Top Ten recoveries were in the healthcare space involving various schemes to defraud Medicare and Medicaid.  So here is our look at the Top Ten healthcare recoveries for...

Catch of the Week: New York-Presbyterian Hospital

Posted  01/26/24
Hospital Building Sign
This week's Department of Justice (DOJ) Catch of the Week goes to New York-Presbyterian Hospital.  Yesterday (January 25), the hospital agreed to pay $801,000 to settle charges it violated the False Claims Act by billing Medicare, Medicaid and TRICARE for medically unnecessary images for radiation therapy treatments provided to cancer patients. The settlement is notable not for the relatively small amount of money...

Top Ten False Claims Act Recoveries in 2023

Posted  01/11/24
It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

January 10, 2024

Clinical laboratory RDx Bioscience Inc. and its owner and CEO Eric Leykin have agreed to pay over $10 million to the federal government and about $3 million to the State of New Jersey for violating the Anti-Kickback Statute and federal and state False Claims Acts.  From 2018 to 2022, RDx and Leykin were allegedly involved with five types of kickback schemes in order to induce referrals to RDx for laboratory testing, then submitted or caused false claims to be submitted to Medicare and Medicaid that were unnecessary or uncovered.  DOJ

January 4, 2024

Florida-based H. Lee Moffitt Cancer Center & Research Institute Hospital Inc. (Moffitt) has agreed to pay over $19.5 million to resolve allegations of violating federal and state False Claims Acts over a 6-year period.  A majority of the settlement proceeds, $18.2 million, will go to the federal government, while $1.3 million will go to the State of Florida.  The hospital allegedly billed the government for items and services that should have been billed to non-government sponsors.  DOJ

December 22, 2023

Christiana Care Health System has agreed to pay over $7.6 million to the State of Delaware for violating the federal and state False Claims Acts, and Delaware’s Patient Brokering and Anti-Kickback laws.  According to a qui tam whistleblower, who filed a case in 2017, the healthcare system provided free or below-market rate support services to doctors in exchange for referrals of Medicaid patients, then submitted false claims stemming from those referrals to Delaware’s Medicaid program.  DE AG

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. DOJ

OIG Identifies Fraud as Top Challenge in 2023 HHS Annual Report - Bring on the Whistleblowers

Posted  11/21/23
Person with Magnifying Glass and Pen Examining Stack of Papers
The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) just released its 2023 Annual Report on its Top Management and Performance Challenges for the past year.  Among the key challenges OIG identified is better protecting HHS programs -- Medicare and Medicaid being chief among them -- from fraud, waste, and abuse.  No big surprise as this is a perennial challenge for the federal...
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