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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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Houston-Area Hospitals Settle FCA Allegations for over $8M

Posted  10/5/17
By the C|C Whistleblower Lawyer Team Four hospitals in the Houston area have agreed to pay $8.6M to settle allegations that they received kickbacks from ambulance companies in exchange for the hospitals’ Medicare and Medicaid transport referrals. The hospitals are Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center, and East Houston Regional Medical Center. All four hospitals...

Mylan Agrees to Pay $465 Million in a False Claims Act Settlement

Posted  08/21/17
By the C|C Whistleblower Lawyer Team Last Friday, the Department of Justice (“DOJ”) announced a $465 million settlement with Mylan, Inc. to resolve claims that it violated the False Claim Act. The suit was brought by a whistleblower under the False Claims Act qui tam provisions and involved the alleged improper misclassification of the EpiPen as a generic drug to avoid paying rebates owed mainly to Medicaid....

DOJ Catch of the Week -- Mylan

Posted  08/18/17
By the C|C Whistleblower Lawyer Team This week's Department of Justice "Catch of the Week" goes to Mylan Inc. and Mylan Specialty L.P. Yesterday, the pharmaceutical companies agreed to pay $465 million to settle charges they violated the False Claims Act by purposely misclassifying EpiPen as a generic drug to avoid paying higher Medicaid rebates. In announcing the settlement, the government stressed its "unwavering...

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, IA

July 7, 2017

Wal-Mart Stores Inc. agreed to pay $1.65 million to resolve allegations it violated the False Claims Act by submitting pharmacy claims to California’s Medi‑Cal program not supported by applicable diagnosis and documentation requirements.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a Wal-Mart pharmacist.  The whistleblower will receive a whistleblower award of roughly $264,000 from the proceeds of the government's recovery.  DOJ (EDCA)

June 30, 2017

Dawn Bentley, a Detroit-area medical biller, was sentenced to 50 months in prison and to pay roughly $3.3 million for her role in a $7.3 million Medicare and Medicaid fraud scheme involving medical services that were billed to Medicare and Medicaid but not rendered as billed.  DOJ

August 4, 2017

Georgia announced a civil settlement with The Medical Center of Central Georgia, Inc., more commonly known as The Medical Center, Navicent Health (Navicent). Navicent agreed to pay to the United States and the State of Georgia $2,549,742 to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary. Additionally, Navicent’s current Corporate Integrity Agreement (CIA) will be heightened and extended to cover the newly resolved conduct. A CIA is an agreement between a private provider of services and the United States whereby the provider, at its own expense, institutes and maintains a program, overseen by the OIG with reviews by an independent review organization, to insure compliance with the laws and regulations regarding participation in federally funded programs. GA

Celgene to Pay $280M to Resolve Fraud Allegations

Posted  07/26/17
By the C|C Whistleblower Lawyer Team Pharmaceutical manufacturer Celgene Corp. agreed to pay $280 million to settle claims that it illegally promoted two cancer drugs, Thalomid and Revlimid, for unapproved uses. The case was filed by a former Celgene sales representative under the False Claims Act, which allows individuals to sue to recover government dollars and share in any recovery. The New York Times reports...

July 17, 2017

New York-based home health care company Visiting Nurse Service of New York and its subsidiaries VNS Choice and VNS Choice Community Care agreed to pay roughly $4.4 million to settle charges of violating the False Claims Act by improperly collecting monthly Medicaid payments for 365 Medicaid beneficiaries whom VNS Choice failed to timely disenroll from the VNS Choice Managed Long-Term Care Plan.  Once VNS disenrolled the members, it did not repay Medicaid for the funds it had improperly received. By knowingly retaining overpayments for many of these members for more than 60 days, the VNS entities violated both the federal and state false claim acts. As a result, New York State will receive $2.63 million as part of the settlement agreement.The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by an undisclosed whistleblower.  The whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)  NY

July 13, 2017

New York announced the convictions of Kenneth Cohn and Sharon Cohn and Yellow Medi-Van and Taxi, Inc., for Medicaid fraud and related charges. Broome County residents Kenneth Cohn and Sharon Cohn owned and operated Yellow Medi-Van and Taxi, Inc., a transportation company providing transportation to medical appointments for Medicaid recipients in Broome County. During the period June 2, 2012, to January 30, 2014, the defendants knowingly operated Yellow Medi-Van and Taxi in violation of Broome County transportation regulations and the New York State Workers’ Compensation Act, by failing to have Worker’s Compensation insurance. The defendants agreed to forfeit and release $455,604.39 of the funds received from Medicaid to the New York State Medicaid Fraud Control Unit. They also entered into a settlement agreement for an additional $50,000.00. NY
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