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Private Insurance Whistleblower Reward Programs

This archive displays posts tagged as relevant to private insurance whistleblower reward laws. You may also be interested in the following pages:

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Top Ten State Fraud Recoveries of 2022

Posted  01/19/23
State and local governments play a critical role in ensuring that businesses and individuals are held accountable if they commit healthcare fraud, financial fraud, government contract fraud, and more. For whistleblowers, state governments can offer additional opportunities to report wrongdoing. Where government funds are at stake – and state and local government spending reaching $3 trillion annually – more...

Tagged in: FCA State, Financial and Investment Fraud, Government Procurement Fraud, Healthcare Fraud, Housing and Mortgage Fraud, Medicaid, Money Laundering, Private Insurance Whistleblower Reward Programs, Top 10,

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Top Ten Healthcare Fraud Recoveries of 2022

Posted  01/6/23
Healthcare fraud image showing stethoscope with gavel
Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare.  As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

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December 5, 2022

Optical lens manufacturer Essilor Laboratories of America, Inc. will pay $23.8 million to California to resolve allegations that the company violated the state’s Insurance Frauds Prevention Act when it allegedly provided kickbacks and other unlawful incentives to eye care providers in exchange for these providers’ promises to send business to Essilor. The state’s action was initiated by a whistleblower complaint filed by Christie Rudolph, who will receive a whistleblower reward of approximately $11.1 million. (see earlier settlement) CA

Tagged in: Medical Devices and DME, Private Insurance Whistleblower Reward Programs, Whistleblower Case, Whistleblower Rewards,

Catch of the Week: 18 Former N.B.A. Players Charged in Healthcare Fraud Scheme

Posted  10/8/21
Former professional basketball players, including Terence Williams, "Big Baby" Glen Davis, Sebastian Telfair, and Tony Allen, have been indicted for submitting fraudulent claims for reimbursement of medical and dental services not actually rendered. From 2017 through last year, defendants' scheme caused the N.B.A. Players' Health and Welfare Benefit Plan ("the Plan") to pay out nearly $4 million in false claims....

Tagged in: Catch of the Week, Criminal Proceedings, Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

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Catch of the Week – Sour Grapes: Fruit-Broker Squashed for Role in Defrauding Federal Crop Insurance

Posted  08/13/21
Grapes
The manager of a California fruit broker learned the hard way that it doesn’t pay to assist in defrauding the Federal Crop Insurance Program.  The manager, at the behest of a grape farmer who sold crops through the broker, altered the farmer’s records to reflect lower-than-actual sales.  The falsified records assisted the farmer to claim crop-losses falsely and receive insurance-reimbursements funded by the...

Tagged in: Catch of the Week, Crop Insurance, FCA Federal, FIRREA, Flood Insurance, Private Insurance Whistleblower Reward Programs,

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New Settlement Shows the Power of Whistleblowers to Root out Fraud against Private Insurers

Posted  08/6/20
whistle hanging against a chalkboard
The nation’s biggest insurers, Medicare, Medicaid, and TRICARE already incentivize whistleblowers to report fraud. Because those programs are federally-funded, a whistleblower can bring suit under the False Claims Act and share in 15-30% of the recovery. The FCA is a law that allows private individuals alleging fraud against the government to bring a lawsuit in the name of the United States. The law leads to about...

Tagged in: FCA Federal, Importance of Whistleblowers, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Whistleblower Case, Whistleblower Eligibility, Whistleblower Rewards,

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How to Be a Whistleblower

Posted  07/19/19
How to be a whistleblower
You know about fraud, waste, abuse, or corruption by an individual or a company. Someone is getting by with cheating -- taking money from the government, taxpayers, or investors, or even harming others, such as patients. You are deeply troubled about it and want the proper authorities to stop it. You are worried whether you will be heard, taken seriously, and protected. You wonder if your information fits within a...

Tagged in: Auto Safety, CFTC Whistleblower Reward Program, Employment Issues, FCA Federal, FCA State, Importance of Whistleblowers, Private Insurance Whistleblower Reward Programs, Retaliation, SEC Whistleblower Reward Program, Whistleblower Answers, Whistleblower Protection Laws, Whistleblower Rewards,

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Skyline Urology - Healthcare Fraud ($2.1 million)

Constantine Cannon represented a whistleblower in a False Claim Act case alleging Skyline Urology misused a billing code to increase reimbursements from Medicare and private insurers in California.  In February 2019, the company agreed to pay roughly $2.1 million to settle the matter. Our client received a whistleblower award of roughly 18% of the government's recovery.  Read more -- NLR, Becker's, DOJ, CC.

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

Healthcare Fraud also Harms Private Insurers - and Whistleblowers can Help

Posted  04/25/19
Health insurance forms, stethoscope, calculator and dollars
Whistleblowers with information about healthcare fraud look first to the False Claims Act, and the impact that healthcare fraud has on Medicare, Medicaid, and other government healthcare spending.  But, healthcare fraud that harms private insurance companies – as opposed to government payors – also attracts government enforcement attention.  Several recent criminal prosecutions in Texas and elsewhere...

Tagged in: Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

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March 14, 2019

The former owner and former COO of Atlanta-based Primera Medical Group, Shailesh Kothari and Timothy McMenamin, were sentenced to prison terms of 6.75 and 7.75 years, respectively, for their roles in submitting more than $8.5 million in fraudulent invoices to private insurance companies for allergy testing and allergy immunotherapy services that were never provided and were not medically necessary.  Defendants submitted bills using the NPIs of doctors who had not performed the tests and, in fact, had no knowledge of the services.  To cover up the fact that the services were not provided, defendants would create false laboratory reports for insurers and patients who requested them.  USAO ND GA

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud,

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