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Whistleblower Rewards

This archive displays posts tagged as including whistleblower rewards. You may also be interested in the following pages:

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March 30, 2020

A whistleblower working in compliance and internal audits has been awarded $450,000 by the SEC.  After efforts to report misconduct internally failed to make a positive impact, the whistleblower reported the same misconduct to the SEC, which helped focus an ongoing investigation and ultimately led to a successful enforcement action.  SEC

Loosening the Rules on Telehealth to Fight Coronavirus May Also Result in New Medicare Fraud Schemes

Posted  03/27/20
doctor-on-phone
In response to the coronavirus pandemic, the U.S. government is loosening rules on telehealth to make it easier—and safer—for patients to speak to their healthcare providers.  These steps are an important, and necessary, step to curtail the spread of the virus and to facilitate the treatment of infected patients.  But it may also open the door to new telehealth fraud schemes by unscrupulous individuals and...

March 24, 2020

Two whistleblowers have received awards totaling over $570,000 for their roles in recent enforcement actions by the SEC.  According to the press release, the first whistleblower received approximately $478,000 and the second whistleblower received approximately $94,000.  In keeping with agency practices, the whistleblowers’ identities have not been revealed.  SEC

March 23, 2020

The SEC has announced that it has awarded a whistleblower over $1.6 million for informing the agency of a possible securities violation and providing critical assistance during the investigation.  Because of the whistleblower’s actions, the SEC was able to successfully enforce securities laws while preserving time and resources.  SEC

March 13, 2020

Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, LLC, have agreed to pay $1.74 million to settle claims of submitting false and inflated claims to Medicare.  From 2011 to 2016, defendants billed and caused Medicare to pay for lower-level wound repairs as if they were more complex adjacent tissue transfers.  The misconduct was eventually exposed by whistleblowers Dr. Robert Green and Emily Kennedy, who will share in a $305,000 award.  USAO MDFL

March 11, 2020

Millennium Physicians Association PLLC, d/b/a Millennium Respiratory & Sleep Disorder Specialists, has agreed to pay $1.2 million to resolve whistleblower-brought allegations of fraud in connection with two sleep centers in Texas.  From 2015 to 2019, Millennium allegedly violated Medicare rules and the False Claims Act by improperly billing Medicare for sleep studies conducted without the presence of properly credentialed technicians.  As part of the settlement, the anonymous relator will receive a $187,344  share of the settlement.  USAO SDTX

Medicaid Drug Rebate Fraud: Should it be an Enforcement Priority?

Posted  03/10/20
pill container spilled over with pills in the form of a dollar sign
Medicaid has one very intuitive approach to keeping drug prices in check. Drug companies, under a law called the Medicaid Drug Rebate Program, must rebate Medicaid programs any money that resulted from the increased drug prices outpacing inflation. Inflation is benchmarked to either 1990, or the first year a drug came to market, which ever is later. As an example of how this works, imagine a pharmaceutical company...

March 4, 2020

STG Healthcare of Atlanta, Inc. and senior executives Paschal Gilley and Mathew Gilley have agreed to resolve fraud allegations by paying $1.75 million.  The case against the hospice was launched by two former employees, Serita Samuel and Miranda Eskridge, who alleged in a qui tam suit that STG Healthcare submitted false claims to Medicare and Medicaid that arose from illegal payments to so-called back-up medical directors, and that were on behalf of patients who were not terminally ill and thus ineligible for palliative care.  GA AG; USAO NDGA

February 28, 2020

Nursing home chain Diversicare Health Services, Inc. has agreed to pay $9.5 million to resolve whistleblower-brought allegations of submitting claims to Medicare and Medicaid for medically unnecessary rehabilitation therapy services.  According to separate qui tam complaints by former employees, Mary Haggard and Bryant Fitzmorris, between 2010 to 2015, Diversicare unnecessarily placed beneficiaries in the highest category of reimbursement in order to receive higher payouts, and submitted forged pre-admission evaluation certifications to Medicaid.  As part of the settlement, Diversicare has entered into a Corporate Integrity Agreement for five years, Haggard will receive approximately $1.4 million, and Fitzmorris will receive approximately $145,450.  DOJ; USAO MDTN

February 28, 2020

Sanofi-Aventis U.S., LLC has agreed to pay $11.85 million to resolve allegations of paying kickbacks to Medicare patients in connection with a multiple sclerosis drug called Lemtrada.  According to the press release, Lemtrada costs nearly $100,000 per patient per year, and Medicare co-pays can be many thousands of dollars per year.  In order to break down barriers to access for Medicare patients, Sanofi allegedly provided kickbacks to them via payments to a purportedly independent charitable foundation, The Assistance Fund (TAF), which helps covers the co-pays in violation of the Anti-Kickback Statute.  The scheme was reported by a partnership formed by Sanofi's predecessor, Genzyme Corporation, which will receive about $2.7 million for their role in the case.  USAO MA
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