Constantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference
Posted 09/10/21
Medicare
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DOJ Reasserts the Proper Role for Agency Guidance in Fraud Cases
Posted 09/3/21
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 CDCACatch of the Week: Telemedicine Company Owner Charged in $784 Million Kickback Scheme
Posted 08/20/21
Court says that fraudsters who violate rules they later claim are unclear may not violate the False Claims Act
Posted 08/19/21
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 SDCAAugust 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 NDCAAugust 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 TennUnited States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente
Posted 07/30/21
