Contact

Click here for a confidential contact or call:

1-212-350-2764

Medicare

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

Page 1 of 33

Regeneron: The Government’s Latest Stand against Patient Kickbacks

Posted  06/25/20
pills, syringes, and money scattered around
This week, Boston-based prosecutors have filed a new False Claims Act case against Regeneron, a pharmaceutical company, alleging that it paid patients kickbacks aiming to steer them into using Regeneron’s macular degeneration drug, Eylea. Regeneron allegedly disguised the kickbacks as charitable contributions to a foundation. Prosecutors say that Regeneron only donated exactly enough money to the foundation, called...

June 25, 2020

Georgia-based Piedmont Healthcare, Inc. has agreed to pay $16 million to resolve whistleblower-brought allegations that it violated the Anti-Kickback Statute and False Claims Act.  The relator in this case, a former Piedmont physician, alleged that between 2009 and 2013, Piedmont’s case managers overturned physician recommendations for outpatient care by submitting claims for more expensive inpatient care to Medicare and Medicaid.  Furthermore, when the healthcare system acquired the Atlanta Cardiology Group in 2007, it allegedly paid far above fair market value for a catherization lab that was partly owned by the practice group.  For bringing a successful enforcement action, the unnamed relator will receive a share of nearly $3 million of the settlement proceeds. USAO SDGA

June 24, 2020

Augusta University Medical Center (AUMC) has agreed to pay $2.6 million to resolve fraud allegations by the United States, State of Georgia, and State of South Carolina under state and federal False Claims Acts.  According to the government, AUMC knowingly submitted claims to Medicare and Medicaid for a medically unnecessary procedure that was billed as a covered procedure.  USAO SDGA

Medicare Risk Adjustment Fraud is Not Victimless

Posted  06/18/20
By Edward Baker
medicare dollars
Implicit in the arguments made by many Medicare Advantage Organizations (MAOs), health plans, hospital networks and other defendants in response to whistleblower and government False Claims Act complaints is that the alleged misconduct—falsifying diagnosis data so that CMS overpays for patients enrolled in an MA plan—involves just a technical record-keeping or administrative dispute with CMS and no actual...

Telehealth Expansion is Here to Stay, We Must Be Wary of Fraud

Posted  05/15/20
doctor-on-phone
Telemedicine, or the provision of medical services through virtual means, has been rapidly expanding for the past several years. In 2010, barely a third of hospitals were offering telehealth services; by 2017, over three-quarters of hospitals were doing so.  Telemedicine has a lot of potential for good. It’s becoming increasingly accessible and affordable thanks to technological advancements. Innovations such...

Keeping Our Eyes Open for COVID-19 Fraud

Posted  05/1/20
coronavirus-map
The COVID-19 pandemic is shaping the way we live around the world and dominating headlines.  Inevitably, it will be a major focus for government enforcement agencies.  The whistleblower team at Constantine Cannon is closely tracking reports of fraud in the Coronavirus response. This week, we launched a new webpage as a hub for COVID-19 fraud news.  We encourage you to visit this page, which will be updated...

COVID Frauds of the Week: Misrepresented Mask Inventories and Medicare Fraud

Posted  05/1/20
N95 Masks
Amid COVID-19-induced fear and hardship, fraud is on the rise. Already, the FTC has received over 18,000 reports of COVID-19 related fraud. In response, the SEC, CFTC, and other regulators announced they are on the lookout for pandemic-related fraud, and the DOJ warned would-be wrongdoers that it will not tolerate profiting off of public panic. This week, we focus on three enforcement actions brought by the...

April 21, 2020

KPMD, Inc., technology company in California, has been ordered to pay $1.7 million in restitution for defrauding Medicare and Medicaid.  According to the DOJ’s press release, KPMD entered into a contract with Ohio-based Southwest Regional Medical Center in 2011 where it agreed to implement an electronic health records software program for the hospital in exchange for government incentive payments under the federal Health Information Technology for Economic and Clinical Health Act (HITECH Act).  After KPMD’s CEO purchased the hospital, however, the company falsely attested to meeting criteria for the incentive payments even though the hospital was winding down operations.  $1.3 million of the settlement will go to Medicare, with the remaining $800,000 to go to Medicaid.  USAO SDOH

April 15, 2020

A Florida-based reference laboratory, pain clinic, and two former executives have agreed to pay $41 million to settle claims of defrauding Medicaid, Medicare, TRICARE, and other government health programs by billing for medically unnecessary urine drug tests between 2010 to 2017.  Led by Michael T. Doyle and Christopher Utz Toepke, the defendants allegedly had a policy of automatically ordering both presumptive and definitive urine drug tests for all patients at every visit regardless of need, with Toepke’s Tampa Pain Relief Centers Inc. performing all presumptive tests, and Doyle’s Logan Laboratories Inc. performing all definitive tests.  The alleged False Claims Act violations were eventually brought to light in two qui tam cases; the whistleblowers of those cases will split a relator’s share of approximately $7.79 million.  DOJ; EDPA; MDFL; FL

April 14, 2020

A chain of nine skilled nursing facilities operating in seven states has agreed to pay $10 million to settle a whistleblower-brought suit alleging violations of the False Claims Act.  In the suit, former employees Hope Wright, Laura Webb, and Deborah Edmonds alleged that from 2013 to 2017, Saber Healthcare Group LLC improperly pressured therapists to provide Ultra High levels of rehabilitation therapy for all patients regardless of individual patient needs.  Ultra High levels of therapy involve a minimum of 720 minutes of therapy from two therapy disciplines, and are reimbursed at the highest rate possible by Medicare.  To enforce their illegal standard, Saber prevented therapists from providing lower levels of therapy, caused therapists to falsely report time, and pressured facility directors in daily or weekly calls.  As part of the settlement, Saber has agreed to a five year Corporate Integrity Agreement, and Wright, Webb, and Edmonds will receive $1.75 million of the settlement proceeds.  DOJ
1 2 3 33

Newsletter

Subscribe to receive email updates from the Constantine Cannon blogs

Sign up for: