Medicare
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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. FLSeptember 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. DOJRose Cancer Center - Healthcare Fraud ($5.7 million)
Constantine Cannon represented a whistleblower in a False Claims Act case alleging Mississippi-based Rose Cancer Center used unqualified technicians performing bone marrow biopsies, diluted chemotherapy drugs, and falsified patient records to conceal the clinic’s fraudulent Medicare billings. The physician who owned and ran the practice plead guilty to various Medicare fraud violations, forfeited $5.7 million, and was sentenced to 20 years in prison. In August 2014, our client (along with three other whistleblowers) received a whistleblower award of $525,000 from the government's recovery. Read more -- Clarion Ledger, CC.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...
Medicare Risk Adjustment: Financial Incentives May Lead to Bad Practices
Posted 10/1/12
AAPC Coding Edge (October 2012), 30-32
Click here to read the article.
Beyond RADV: Does Your Plan's Risk Adjustment Strategy Run Afoul of the False Claims Act
Posted 02/13/12
Presented at the HCCA Managed Care Compliance Conference (February 13, 2012). Click here to view the presentation.