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Medical Billing Fraud

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August 12, 2014

New York Attorney General Eric T. Schneiderman announced that the Northern Manor Multicare Center nursing home agreed to pay $6.5M to resolve allegations it was not providing services as represented in its claims for payment to Medicaid. NYAG

April 14, 2014

Hope Cancer Institute, a cancer treatment facility in Kansas, and its owner Dr. Raj Sadasivan, agreed to pay $2.9M to resolve allegations they violated the False Claims Act by submitting claims to Medicare, Medicaid and the Federal Employee Health Benefits Program for chemotherapy drugs and services not actually provided.  The allegations were first raised in a qui tam lawsuit filed by former employees of the facility Krisha Turner, Crystal Dercher and Amanda Reynolds under the whistleblower provisions of the False Claims Act.  DOJ

August 19, 2013

Shands Teaching Hospital & Clinics agreed to pay $26M to settle allegations that six of its health care facilities submitted false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

Health Line Clinical Laboratories — Medicare Fraud/Unnecessary on Nonexistent Testing ($10 million).

One of our whistleblower attorneys led the representation of two whistleblowers who brought a qui tam action under the False Claims Act alleging the medical laboratory was charging for tests not performed or not necessary. For many of the tests involved, records suggested treating physicians had ordered over inclusive “747” panels, and the defense relied heavily on these order forms. The Department of Justice was persuaded the defendants’ conduct caused the unnecessary testing and intervened. Following the defeat of motions to dismiss and focused discovery the case settled for $10 million. The whistleblowers received 18% of the government recovery.
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