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Medicare

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

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Congress Highlights Medicare Part D Plans’ Failure To Prevent Fraud

Posted  07/16/15
Fraud in the Medicare Part D prescription drug program is getting the attention of not only the Department of Health and Human Services’ Office of the Inspector General (HHS OIG) but also watchdogs on Capitol Hill.  On Tuesday, July 14, 2015, the House of Representatives’ Committee on Energy and Commerce held a hearing to examine two recent reports from HHS OIG examining improper spending in the Medicare Part...

DOJ Gives Major Shoutout To Whistleblowers In $450M DaVita False Claims Act Settlement

Posted  06/26/15
By Gordon Schnell On Wednesday, Denver-based provider of dialysis services DaVita Healthcare Partners, Inc. agreed to pay $450 million to resolve charges it violated the False Claims Act by purposely creating and then billing the government for unnecessary waste in administering the drugs Zemplar and Venofer to dialysis patients.  DaVita is the largest provider of dialysis services in the US with dialysis clinics...

June 18, 2015

Florida joined the federal government in announcing charges against 73 South Florida residents for their alleged participation in various schemes to defraud Medicare and Medicaid out of more than $262 million. FL

DaVita — Medicare Fraud/Kickbacks ($400 million).

Two of our whistleblower attorneys led the representation of David Barbetta, a former financial analyst for DaVita HealthCare Partners, one of the largest providers of dialysis services in the United States. Mr. Barbetta brought a qui tam action under the False Claims Act against DaVita alleging the company violated the Anti-Kickback Statute by paying physicians to refer their patients to DaVita clinics for dialysis. According to the complaint, DaVita sold doctors shares of DaVita clinics at below fair market value, and purchased doctors’ interests in other clinics at above fair market value. The government joined the case, and alleged that DaVita had entered into these sweetheart deals with doctors, which gave the doctors returns of over 100%, and the doctors then steered their patients to DaVita clinics. In 2014, DaVita paid $400 million to settle the case, the largest stand-alone kickback settlement ever, and Mr. Barbetta received a whistleblower award of over $65 million. See Denver Post and Modern Healthcare for more.

September 26, 2014

Pharmacy benefit management (PBM) company Caremark LLC agreed to pay $6 million to settle charges of failing to reimburse Medicaid for prescription drug costs that should have been paid for by Caremark-administered private health plans.  Caremark is operated by CVS Caremark Corporation, one of the largest PBMs and retail pharmacies in the country.  Donald Well, former employee of Caremark, will receive a whistleblower award of $1 million from the $6 million False Claims Act settlement. DOJ

Rose Cancer Center — Medicare Fraud ($5.7 million).

Two of our whistleblower attorneys co-led the representation of Kristi Beeson who reported Medicare fraud violations at her former employer Rose Cancer Center in Mississippi. Ms. Beeson, who was a laboratory technician for the clinic, brought a qui tam action under the False Claims Act against the clinic alleging, among other things, unqualified technicians performing bone marrow biopsies, diluting chemotherapy drugs, and doctoring patient records to conceal the clinic’s fraudulent Medicare billings. The physician who owned and ran the practice, Dr. Meera Sachdeva, plead guilty to various Medicare fraud violations, forfeited $5.7 million, and is now serving a 20 year prison sentence for her crimes. Ms. Beeson, along with three other whistleblowers, collectively received a whistleblower award of $525,000 for their efforts in exposing the fraud. See Clarion Ledger for more.

DOJ Catch of the Week – Vascular Solutions

Posted  08/1/14
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to Vascular Solutions Inc (VSI).  On Monday, the Minneapolis-based medical device maker agreed to pay $520,000 to resolve allegations that it violated the False Claims Act by marketing a product for sealing veins without FDA approval.  Specifically, the government charged that VSI marketed and sold its "Vari-Lase...

More Trouble for Orthofix

Posted  12/20/12
By Marlene Koury Medical device maker Orthofix, Inc. this week obtained court approval for its June 2012 settlement proposal to resolve civil and criminal allegations that it defrauded Medicare through kickback schemes and overbilling for its bone-growth stimulators.  Click here for the original government press release.  The company will pay approximately $43 million for its misdeeds.  This payment follows on...

Beyond RADV: Does Your Plan's Risk Adjustment Strategy Run Afoul of the False Claims Act

Posted  02/13/12
CC Attorney Mary Inman
Presented at the HCCA Managed Care Compliance Conference (February 13, 2012).  Click here to view the presentation.
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