September 22, 2015
False Claims Act Information
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
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
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
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 […]
September 16, 2015
Mortgage Fraud
In yet another mortgage fraud case, Walter Investment Management Corporation (Walter Investment) has agreed to pay over $29 million to resolve allegations it falsely certified residential home mortgages under the Department of Housing and Urban Development’s (HUD) Home Equity Conversion Mortgage (HECM)[1] program. The alleged scheme was uncovered following a […]
September 15, 2015
Contractor Fraud
The Savannah River Site is a nuclear facility built in the 1950s and maintained by the federal government via several contracts with engineering and environmental firms. According to its mission statement, the site is “a key Department of Energy (DOE) industrial complex responsible for environmental stewardship, environmental cleanup, waste management […]
September 14, 2015
Healthcare Fraud
Much like healthcare providers are prohibited from providing kickbacks to doctors and patients, pharmacies are likewise prohibited from inducing potential customers by offering financial incentives to choose one dispensary over another. In essence, the government seeks to ensure Medicare enrollees are free to choose the pharmacy of their liking without […]
September 9, 2015
Healthcare Fraud
In yesterday’s post, we reviewed a controversial phenomenon plaguing the international drug market involving the production of substandard generic medications in India. More specifically, we looked at how patients in America and worldwide could face harm by taking drugs manufactured by companies like Ranbaxy, as studies have revealed that key […]
September 8, 2015
Healthcare Fraud
Over the next two posts, we’ll explore a growing international problem involving the safety of generic drugs produced overseas. Namely, generic medications produced in India – including those manufactured by False Claims Act offender Ranbaxy – are becoming more and more problematic, due in part to the alleged falsification of […]
September 7, 2015
Healthcare Fraud
Under the guidelines of Medicare Part B, enrollees are entitled to coverage for medically necessary and essential diagnostic services, including bloodwork, x-rays, and similar imaging examinations. If a provider fails to adhere to the Medicare guidelines, it could quickly face liability under the False Claims Act for unlawfully billing the […]
September 4, 2015
Healthcare Fraud
Following a lengthy investigation by both the state of New York’s Medicaid Fraud Control Unit and the U.S. Attorney’s Office for the Eastern District of New York, several medical corporations operating in the state have agreed to pay $8 million to settle allegations of fraud against Medicaid and Medicare. The […]
September 3, 2015
False Claims Act Information
In yesterday’s post, we reviewed two concepts that often serve as the basis of a whistleblower’s complaint under the False Claims Act. The first is known as a condition of payment violation, which occurs when a provider knowingly submits a claim for reimbursement to Medicare or Medicaid in violation of […]