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Catch of the Week: CMS Suspends UnitedHealth and Anthem Medical Advantage Plans for Charging Too Much in Premiums

Posted  09/24/21
Medicare Card
CMS suspended three UnitedHealth Medicare Advantage (MA) plans and one Anthem MA plan this week for failing to meet federal Medical Loss Ratio requirements. The four plans – United of the Midwest, United of New Mexico, United of Arkansas, and Anthem’s MMM Healthcare – are prohibited from enrolling new members until 2023. MMM Healthcare is the largest MA plan in Puerto Rico, with more than 260,000...

September 15, 2021

A cardiologist in Florida who allegedly billed Medicare and Medicaid for medically unnecessary procedures has agreed to pay $6.75 million to resolve claims under the False Claims Act.  Between 2013 and 2019, Dr. Ashish Pal allegedly made misrepresentations in patient medical records to justify ablations and vein stent procedures that were not reimbursable under program rules.  Additionally, some of the procedures were later found to have been performed primarily by unqualified ultrasound technicians.  As part of the settlement, Pal and Interventional Cardiology & Vascular Consultants, PLC, will enter in a multiyear integrity agreement and comply with training and reporting requirements, as well as a quarterly claims review by an independent organization.  USAO MDFL

Constantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference

Posted  09/10/21
stethoscope on top of hundred dollars bills scattered around
Building on Constantine Cannon’s reputation as the preeminent law firm representing whistleblowers in FCA cases involving Medicare Advantage (MA) risk adjustment fraud, three Constantine Cannon attorneys, Mary Inman, Ed Baker, and Max Voldman, recently presented on case developments in this fast-developing area of the law at RISE West, a national conference for healthcare professionals working in the managed care...

DOJ Reasserts the Proper Role for Agency Guidance in Fraud Cases

Posted  09/3/21
Department of Justice Logo
The Justice Department has quietly rescinded a Trump administration policy that was needlessly undermining the role of government agency guidance.  On July 1, 2021, Attorney General Merrick Garland issued a memorandum revoking what is known as the Brand Memo.  In her memo, Former Associate Attorney General Rachel Brand had set out a position that defense attorneys scrambled to use to argue for leniency or...

August 25, 2021

A California-based provider of home respiratory services and durable medical equipment has agreed to pay $3.3 million to the United States and States of California and Nevada to settle allegations of defrauding Medicare and Medicaid.  The claims against SuperCare Health, Inc. were brought in a 2018 qui tam suit by respiratory therapist Benjamin Martinez, who alleged that the provider billed for non-invasive ventilators (NIVs) that were no longer needed or being used by patients.  CA AG; USAO CDCA

Catch of the Week: Telemedicine Company Owner Charged in $784 Million Kickback Scheme

Posted  08/20/21
Doctor on computer with patient discussing medicine
Underscoring the fraud risks associated with the government’s continued expansion and loosening of restrictions on telehealth, the U.S. Department of Justice recently announced that a grand jury in New Jersey has returned a superseding indictment against the Florida owner of multiple telemedicine companies, referred to by DOJ prosecutors as the Video Doctor Network, for allegedly participating in a massive Medicare...

Court says that fraudsters who violate rules they later claim are unclear may not violate the False Claims Act

Posted  08/19/21
Red and yellow pills scattered on hundred dollar bills
Last week, the Seventh Circuit Court of Appeals, the federal appellate court for Illinois, Indiana, and Wisconsin decided U.S. ex rel. Yarberry v. Supervalu, an important decision that may lead more unscrupulous government contractors to help themselves to public funds to which they are not entitled.  Unless the Supreme Court or Congress steps in to correct the Seventh Circuit’s errors, the government may have...

August 6, 2021

Maryland-based National Spine & Pain Center (NSPC) and its affiliate, Physical Medicine Associates, Ltd. (PMA), have agreed to pay $5.1 million to Medicare and enter into a non-prosecution agreement to settle a criminal fraud investigation.  In violation of the Anti-Kickback Statute, NSPC and PMA had conspired with a now-defunct California-based genetics testing company called Proove Biosciences to have Proove pay illegal kickbacks to NSPC and PMA physicians in exchange for a certain volume of test referrals.  Nine individuals have been charged in connection with the scheme.  USAO SDCA

August 6, 2021

A county in California and a county medical center have agreed to pay $11.4 million to resolve allegations of improperly billing a federal healthcare program between 2013 and 2017.  According to whistleblower Felix Levy, a former employee of San Mateo County Medical Center (SMMC), San Mateo County and SMMC billed Medicare for uncovered hospital stays for patients that were admitted without regard to medical necessity.  USAO NDCA

August 2, 2021

Diabetic testing supply company Arriva Medical LLC and its parent company Alere Inc. will pay $160 million to resolve claims first brought in a whistleblower case alleging that Arriva provided unlawful patient inducements in the form of “free” or “no cost” glucometers and copayment waivers.  Defendants were alleged to have systematically provided all new patients with glucometers, and billed Medicare for those meters, although Medicare beneficiaries are only eligible for a new meter once every five years.  In addition, Arriva was alleged to have billed Medicare for deceased beneficiaries.  The whistleblower, Gregory Goodman, who was an employee at an Arriva call center, will receive a whistleblower award of $28.5 million.  Executives at Arriva previously agreed to a settlement of claims against them.  DOJ; USAO MD Tenn
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