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August 20, 2015 Healthcare Fraud

Tennessee Hospital Agrees to Settle Allegations of False Billing and Unlawful Practices

Of the various ways in which healthcare providers can violate the False Claims Act, ordering medically unnecessary procedures – particularly those involving the cardiac system – are considered particularly egregious. As opposed to illegal upcoding or kickback schemes, the performance of medically unnecessary procedures actually places patients directly in harm’s […]
August 19, 2015 Healthcare Fraud

Government Accountability Office Alerts Congress to Medicare & Medicaid Eligibility Issues

In fiscal year 2014, American taxpayers footed a $554 billion dollar bill for Medicare and Medicaid – two programs that, while essential in nature, are exceedingly strapped for resources. As one of the hallmark goals of the False Claims Act, authorities have worked diligently to ensure providers are billing correctly […]
August 18, 2015 False Claims Act Legal News

D.C. Circuit Court Upholds ‘Implied Certification Theory’ in Recent False Claims Act Case

In yesterday’s post, we explored the concept of implied certification under the False Claims Act – a theory which somewhat eliminates the requirement for explicit false claims activity, but requires evidence that the defendant knew or should have known his activity did not comply with a government contract, but continued […]
August 17, 2015 False Claims Act Information

Implied Certification Theory in False Claims Act Cases

A defendant may be liable under the False Claims Act on two different theories: the presentment of factually false claims and the presentment of legally false claims. A claim is factually false when a government payee submits information that is untrue on its face and misrepresents the goods or services […]
August 14, 2015 Military Contractor Fraud

Federal Government Examines Helicopter Manufacturer Sikorsky Amid Allegations of Fraud

Aside from healthcare fraud, defense contractor fraud remains one of the top forms of waste and abuse addressed by the False Claims Act. Too often, big-budget defense contracts serve as fodder for dishonest companies to inflate and exaggerate costs, resulting in unnecessary spending of an already-strained defense budget. In one […]
August 13, 2015 Healthcare Fraud

Berger Montague Settles Whistleblower Lawsuit Involving AstraZeneca, Cephalon, & BioGen, Inc.; Secures $55 Million on Behalf of Taxpayers

As one of the leading and most successful whistleblower law firms in the United States, Berger Montague is pleased to announce its involvement in a $55.5 million settlement involving three major players in the pharmaceutical industry. This past July, Berger Montague announced the settlement against AstraZeneca, Cephalon, Inc., and BioGen, […]
August 12, 2015 Healthcare Fraud

Improper ‘Balance Billing’: Examples of a Rising Trend

In yesterday’s post, we introduced an emerging concept known as “balance billing,” which results in skyrocketing medical expenses and increased medical debt for unsuspecting patients. As a brief review, balance billing occurs when a patient seeks treatment from an out-of-network doctor, who then bills the patient for the maximum allowable […]
August 11, 2015 Healthcare Fraud

Emerging Fraud Trends: The Rise of Balance Billing

At Berger Montague, we strive to keep on top of the latest emerging trends in the fraud landscape, particularly when the misconduct drives up the costs of healthcare for policyholders and taxpayers alike. Over the next two posts, we will examine an emerging fraud trend known as “balance billing,” which […]
August 10, 2015 Healthcare Fraud

Judge Orders Near-Maximum Whistleblower Reward; Cites ‘Indispensable Contribution’

One of the key components of the success of the False Claims Act is its ability to incentivize whistleblowers to come forward by offering up to 30 percent of the total settlement in some cases. In today’s post, we examine an interesting holding by the U.S. District Court for the […]
August 7, 2015 Military Contractor Fraud

False Claims Act Lawsuit Settled Against South Carolina’s Covan World Wide Movers, Inc.

False claims occur in virtually every aspect of federal contract work. In today’s case, we look at a recent multi-faceted settlement, the details of which have been ongoing for most of 2015, involving relocation services for U.S. military members. The case was brought to light by several employees of the […]
August 6, 2015 Healthcare Fraud

OIG Raises Concerns Over Possible Abuse of Controlled Substances Within Medicare Part D

In yesterday’s post, we introduced a possible correlation between the growth of Medicare spending on highly-addictive prescription drugs and potential Medicare fraud by wayward retail pharmacies. As a bit of review, spending for Medicare Part D administration has increased 136 percent overall since 2006. However, spending for opioids – including […]
August 5, 2015 Healthcare Fraud

New Report Highlights Growing Trend of Medicare Part D Fraud & Opioid Abuse

Over the next two posts, we will examine a recent report published by the Office of Inspector General, along with the U.S. Department of Health and Human Services. In the report, which is entitled “Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D,” authorities […]
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