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Other Government Health Programs

This archive displays posts tagged as relevant to government healthcare programs other than Medicare and Medicaid, and fraud in those programs. You may also be interested in our pages:

Page 14 of 18

United States Targets a Private-Equity Firm and Pharmacy in a Whistleblower Case

Posted  02/26/18
By the C|C Whistleblower Lawyer Team On Friday the Wall Street Journal reported on the U.S. government’s decision to intervene in a False Claims Act qui tam case against pharmacy Diabetic Care Rx LLC and the private equity firm that holds a controlling stake in the pharmacy, Riordan Lewis & Haden Equity Partners (“RLHEP”). Diabetic Care is a compounding pharmacy that mixes different ingredients to create...

Tagged in: Compounding Pharmacy Fraud, Defendants, FCA Federal, Other Government Health Programs, Pharma Fraud, Whistleblower Case,

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Fraudster of the Week -- Pharmacy Fraudster Steven Butcher

Posted  02/16/18
By the C|C Whistleblower Lawyer Team On Wednesday, former pharmaceutical sales representative Steven Butcher admitted to running a $45 million scheme to swindle both federally-funded and private health care benefit programs.  Butcher was charged with one count of conspiracy to commit health care fraud and one count of conspiracy to violate the Anti-Kickback Statute, a law designed to remove financial incentives...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Compounding Pharmacy Fraud, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

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Fraudster of the Week -- Former Football Player Monty Grow

Posted  02/9/18
By the C|C Whistleblower Lawyer Team On Monday, a federal jury in Miami unanimously convicted Monty Grow of running a compound pharmaceutical drug conspiracy that bilked $20 million from TRICARE, a healthcare program for military members and their families. Grow was a star linebacker at the University of Florida in the early 1990s and spent two seasons as a cornerback in the NFL. Prosecutors accused Grow of...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Compounding Pharmacy Fraud, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

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Tampa’s Largest Ambulance Providers Will Pay $5.5M to Resolve Whistleblower-Initiated Suit

Posted  01/31/18
By the C|C Whistleblower Lawyer Team AmeriCare Ambulance Service, Inc. and its sister company, AmeriCare ALS, Inc. have reached a $5.5 million settlement with the government, resolving allegations that AmeriCare defrauded Medicare by billing for medically unnecessary ambulance transportation services. According to the government’s complaint, AmeriCare submitted fraudulent claims to Medicare and TRICARE for...

Tagged in: Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

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Medical Device Company to Pay $7.62 Million FCA Settlement

Posted  01/24/18
By the C|C Whistleblower Lawyer Team Yesterday, the Department of Justice announced a $7.62 million settlement with California-based DJO Global Inc. to resolve allegations that a DJO subsidiary falsely billed TRICARE for excessive and unnecessary supplies. The government alleged that the DJO subsidiary used an improper “assumptive selling” technique to induce TRICARE beneficiaries to order supplies that they did...

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Devices and DME, Other Government Health Programs,

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January 10, 2018

Florida pharmacy Healthy Meds Pharmacy Corp. agreed to pay $350,000 to settle allegations under the False Claims Act for filling prescriptions in violation of TRICARE’s policy on telemedicine.  According to the government, Healthy Meds engaged in unsolicited calls to TRICARE beneficiaries, provided medically unnecessary compound medications to beneficiaries, and knowingly filled prescriptions from doctors who did not meet or properly consult with TRICARE beneficiaries. DOJ (SDFL)

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Lack of Medical Necessity, Other Government Health Programs,

December 18, 2017

Florida-based pharmacy Glades Drugs, Inc. agreed to pay $300,000 to settle allegations of violating the False Claims Act by waiving or failing to collect required copayments from Medicare and TRICARE beneficiaries. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Glades pharmacy technician Elvens Vertus. Vertus will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (SDFL)

Tagged in: FCA Federal, Medicare, Other Government Health Programs, Pharma Fraud,

November 30, 2017

Florida-based Express Plus Pharmacy, LLC and its owner Antonio Primo agreed to pay $170,000 to resolve allegations they violated the False Claims Act by submitting fraudulent claims to Tricare for compounded medications such as pain creams that were not reimbursable because they were not issued pursuant to valid physician-patient relationships, were issued after brief phone calls with patients that violated applicable law on telemedicine, were medically unnecessary, and/or were tainted by kickbacks to marketers.  DOJ (SDFL)

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Pharma Fraud,

Fraudster of the Week -- TRICARE Fraudster Joseph Baumiller

Posted  10/20/17
By the C|C Whistleblower Lawyer Team On Tuesday, 38-year-old Joseph Baumiller of Dallas, Texas pleaded guilty to one count of conspiracy to defraud TRICARE, the health care program serving military members and their families. Baumiller, the former president of Trilogy Pharmacy, admitted to conspiring with several marketers, physicians, and other pharmacists to orchestrate a scheme involving the payment of kickbacks...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Compounding Pharmacy Fraud, Other Government Health Programs, Pharma Fraud,

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Ninth Circuit Finds Materiality in the Face of Continued Government Payment

Posted  07/14/17
By Rosie Dawn Griffin Earlier this month, the U.S. Court of Appeals for the Ninth Circuit revived United States ex rel. Campie v. Gilead Scis., a False Claims Act (FCA) suit against pharmaceutical giant Gilead Sciences and, in doing so, provided the qui tam bar with additional guidance on how the lower courts will interpret the Supreme Court’s emphasis on materiality in Universal Health Services, Inc. v....

Tagged in: FCA Federal, FCA Materiality, FDA Fraud, Other Government Health Programs, Pharma Fraud, Whistleblower Case,

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