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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 […]
August 4, 2015 Healthcare Fraud

UPDATE: Georgia Hospital Settles Amid Allegations of Unlawful Kickbacks in Exchange for Obstetric Referrals

In 2014, we covered the government’s decision to intervene in a False Claims Act lawsuit involving several Central Georgia-area hospitals and possible Medicaid fraud. As a bit of review, the case involved several hospitals, including Tenet Healthcare, Health Management Associates, and Clinica de la Mama, an OB/GYN facility geared toward […]
August 3, 2015 False Claims Act Legal News

Berger Montague Exploring Possible Fraud Within Indexed Universal Life Insurance Policies

An indexed universal life insurance policy is a financial product designed to offer policyholders a variable return rate on their insurance funds, usually tied to the daily rates as set by entities like Standard & Poor’s. More specifically, these policies – which are predominantly similar to traditional universal life insurance […]
July 30, 2015 Healthcare Fraud

Multiple Whistleblower Lawsuits Against Novartis Could Amount to $3 Billion in Fines and Penalties

In one of the largest potential whistleblower settlements[1.] to date, drug maker Novartis is facing a staggering $3.35 billion in fines and penalties from the Department of Justice over two of its best-selling prescription medications: Exjade and a treatment for kidney transplant patients. In a separate concurrent whistleblower lawsuit against the […]
July 29, 2015 Healthcare Fraud

AstraZeneca & Celaphon to Pay Whopping $54 Million to Settle Claims of Fraud Against Medicaid

In today’s case, we examine a recent False Claims Act settlement involving the Medicaid drug rebate program. The drug rebate program[1.] is essentially a partnership between the Center for Medicare and Medicaid Services (CMS), state Medicaid offices, and private drug manufacturers. Generally, private drug manufacturers are offered the opportunity to […]
July 28, 2015 Healthcare Fraud

UPDATE: Tuomey Healthcare System Loses Appeal; Owes Quarter-Billion in False Claims Act Verdict

In 2013, we covered a historic False Claims Act verdict entered by the U.S District Court for the District of South Carolina against Tuomey Healthcare System. In that case, a whistleblower-physician alleged that the company was requiring doctors to agree to referral schemes that violated both the False Claims Act […]
July 27, 2015 Contractor Fraud

VMWare Settles FCA Allegations for $75 Million Following Five Year Investigation

Government contract work can be extremely lucrative, providing companies with a regular stream of income and dependable job security for their employees. Accordingly, the risk for rampant fraud and abuse of taxpayer resources is also very common, particularly when it comes to adhering to the ironclad provisions in the government’s […]
July 24, 2015 Healthcare Fraud

Indianapolis Health Network Agrees to Settle False Claims Act Allegations for $20 Million

When it comes to reimbursement for surgical procedures, Medicare and Medicaid maintain strict guidelines with regard to the location of the surgery and whether it took place in a hospital or independent facility. Recognizing that hospitals have a much higher overhead rate, and generally cost more to operate and maintain, […]
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