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October 2, 2015 IRS Whistleblower

Combating Tax Fraud: The IRS Whistleblower Program

Much like the whistleblower procedure under the False Claims Act, the Internal Revenue Service maintains a whistleblower program whereby relators can relay information concerning possible tax fraud in exchange for the opportunity to receive a percentage of the ultimate recovery. While it is utilized less than the False Claims Act— […]
October 1, 2015 Healthcare Fraud

Optometry and Cardiology Fraud: Recently Unsealed Whistleblower Cases

In yesterday’s post, we examined some of the trends in recently unsealed qui tam lawsuits as surveyed by the National Law Review.[1.  “September Health Care Qui Tam Update,” The National Law Review, September 21, 2015,] Of the 39 unsealed cases that were surveyed, many involve allegations of wasteful, and even […]
September 30, 2015 Healthcare Fraud

Healthcare Fraud Unsealed: Recently-Unsealed Whistleblower Lawsuits Show Variety of Fraudulent Medical Claims

Under the terms of the False Claims Act, an original whistleblower complaint must be filed confidentially under seal within a federal district court. From there, the Department of Justice receives notice of the lawsuit and is afforded an opportunity to investigate the allegations on its own. In about 20 percent […]
September 29, 2015 Healthcare Fraud

Adventist Health System Pays Massive $118 Million False Claims Act Settlement

In yet another case of illegal kickbacks and unlawful referrals, Florida-based Adventist Health System has agreed to pay $118 million to the federal government pursuant to several successful whistleblower actions filed by former employees of the corporation. Adventist is a non-for-profit healthcare corporation that manages facilities in ten states. According […]
September 28, 2015 Customs Fraud

Aluminum Importer Agrees to Settle False Claims Act Allegations Over Import Duties

In a recent settlement under the False Claims Act, two individuals have agreed to pay $435,000 to resolve allegations they “skirted” their obligation to pay duties on aluminum extrusions imported from Chinese aluminum manufacturer Tai Shan Golden Gain Aluminum Products. The defendants, who hail from New Jersey and Texas, will […]
September 25, 2015 False Claims Act Information

4 Common Defenses Raised in False Claims Act Lawsuits

As a potential whistleblower, it is important to recognize the common defenses raised by defendants as they attempt to avoid massive penalties, fines, and negative publicity. If you are considering a whistleblower lawsuit, you may be concerned by the prospect of taking on a large, multi-national conglomerate as an individual […]
September 24, 2015 Healthcare Fraud

North Broward Hospital District Agrees to Pay $69 Million to Settle Claims of Illegal Kickbacks

The False Claims Act – and its companion statute, the Stark Law – expressly forbid hospital corporations from offering any sort of kickback or incentive in exchange for patient referrals or recommendations of certain products. These rules stem from the notion that patients should receive medical advice untainted by a […]
September 23, 2015 Healthcare Fraud

Columbus Regional Health System Settles False Claims Act Allegations for $35 Million

The Columbus Regional Health System, which maintains several hospitals, clinics, and a retirement community in the Columbus, Georgia area, has agreed to pay $35 million to settle allegations that it offered lucrative kickbacks and incentives to physicians in violation of the False Claims Act and Stark Law. Both laws prohibit […]
September 22, 2015 False Claims Act Information

Department of Justice Issues Guidance to Federal Prosecutors Working in Corporate Fraud Investigations

The Department of Justice has been concerned with the rising trends of healthcare, defense, and contractor fraud against the U.S. government. Many of these cases involve large corporate conglomerates with multinational field offices and a global presence. Investigating and prosecuting these complex entities under the False Claims Act and other […]
September 21, 2015 Medicaid Fraud

Tennessee Hospice Center to Pay $1.5 Million to Resolve Allegations of Medicaid Fraud

In today’s case, we look at the Nashville-based nonprofit hospice center Alive Hospice, who is alleged to have admitted patients who did not meet the criteria for hospice coverage, and to have intentionally defrauded the government by submitting claims on behalf of these patients. While Alive Hospice representatives publicly disagreed […]
September 18, 2015 False Claims Act Information

Fraud Against the Government and the False Claims Act: 5 Common Red Flags

The False Claims Act got its start in the Civil War era after dozens of wayward contractors acquired substantial sums of money from the government despite delivering subpar (or nonexistent) supplies to soldiers. Since then the Act has been applied to virtually every industry in the United States, resulting in […]
September 17, 2015 Healthcare Fraud

Georgia Optometrist Settles Allegations of False Billing and Upcoding for $275,000

State and federal guidelines impose strict billing requirements when it comes to routine eye care. Unlike many private insurance plans, coverage under Medicare or Medicaid generally provides reimbursement for vision services, provided the optometrist engages in medically necessary procedures. Today we’ll review a whistleblower case filed in 2014 against optometrist […]
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