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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. http://taf.org/blog/costly-kickbacks-novartis-potentially-faces-3-billion-fines] 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. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html] 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, […]
July 23, 2015
Healthcare Fraud
The Children’s Hospital Agrees to Pay Nearly $13 Million to Settle False Claims Act Allegations
Proving that healthcare fraud truly knows no bounds, the Children’s National Medical Center – through its Children’s Hospital Medical Graduate Program – is accused of engaging in costly and wasteful healthcare fraud involving various pediatric patients enrolled in the Medicaid program. Consequently, the hospital has agreed to pay a staggering […]
July 22, 2015
Medicaid Fraud
NY Attorney General Settles with Walgreens Pharmacy Over Unlawful Medicaid Billing Allegations
With one of the most active and often-used state False Claims Acts, New York has once again taken aim at alleged misconduct within the healthcare industry. According to a recent announcement by the New York Attorney General’s Office, the popular Walgreens pharmacy and its subsidiary Trinity Homecare, LLC have reached […]
July 21, 2015
Healthcare Fraud
Lawsuits Allege Inflated Risk Adjustment Scores, Resulting in False Claims
In yesterday’s post, we introduced the concept of risk assessment scores, and how the Center for Medicaid and Medicare Services (CMS) relies on information reported by healthcare facilities to adjust reimbursement rates [1. Medicare Managed Care Manual, Chapter 7. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c07.pdf] for certain demographics and regional areas. As a review, certain […]
July 20, 2015
Healthcare Fraud
Courts Considering Concept of Inflated ‘Risk Adjustment Scores’ Under the False Claims Act
According to a report published by the Center for Public Integrity, as many as six separate whistleblower lawsuits have been filed since 2010 alleging inflated ‘risk adjustment scores’ submitted to the Center for Medicare and Medicaid Services (CMS). This paradigm shift in alleging false claims centers on the notion that […]
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