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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.] 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 […]
July 17, 2015 Healthcare Fraud

Hamilton Healthcare Accused of Allowing Excluded Practitioner to Treat Medicare and Medicaid Patients

As a healthcare practitioner, permission to work with Medicaid and Medicare participants can be an extremely lucrative area of practice. For many physicians working in areas with an aging or low-income demographic, government healthcare enrollees can quickly become a large majority of the patient load – which can often invite […]
July 15, 2015 Contractor Fraud

Watry Homes, LLC, Accused of Underpaying Workers on Government Housing Projects

In today’s post, we explore a form of trickery involving underpayment of workers tasked with constructing federally-funded housing in the Milwaukee, Wisconsin, area. Watry Homes, LLC, has settled both civil and criminal charges stemming from a massive payroll fraud scheme costing taxpayers millions of dollars and resulting in the extreme […]
July 6, 2015 Healthcare Fraud

Tulsa Doctor and Clinic to Settle Allegations of Medicare Fraud for $105,000

In today’s post, we will explore a recent $105,000 settlement involving a Tulsa, Oklahoma, physician accused of defrauding the taxpayer-funded Medicare system, which serves millions of Americans aged 65 and older with affordable health insurance coverage.[1. Department of Justice Press Release, “Settlement Reached In Medicare Fraud Lawsuit Against Tulsa Doctor And […]
July 3, 2015 Healthcare Fraud

Houston Hospital Leaders Sentenced to 45 Years in Prison for Alarming Medicare Fraud Scheme

The Riverside General Hospital first opened its doors in the 1960s amid a torrent racial climate, becoming one of the first hospitals to de-segregate and operate on policies of inclusion and equality. Since then, it has faced untold financial struggles, including a recent indictment stemming from allegations of nine-figure financial […]
July 2, 2015 Healthcare Fraud

Hebrew Homes Health Network Settles Allegations of Medicare Fraud With the Department of Justice

Florida is one of the top retirement havens in the United States. Accordingly, it is one of just a handful of areas specifically targeted by Medicare fraud task forces, as the potential for scams and misconduct is congruently heightened by the increasing elderly population. In today’s post, we review a […]
July 1, 2015 Healthcare Fraud

Florida Plastic Surgeon Settles Medicare Fraud Lawsuit for $4 Million

In a recent settlement between the Department of Justice and a Florida cosmetic surgeon, the latter has agreed to pay $4 million to settle expansive allegations of Medicare fraud.[1. Department of Justice Press Release, “Florida Physician Agrees to Pay $4 Million and To Accept a 5-Year Exclusion From Medicare to Resolve […]
June 30, 2015 Healthcare Fraud

Department of Justice Turns Eye Toward Settlement Over Off-Label Marketing of Conjunctivitis Drug

When reimbursing for prescription medication, agencies like Medicare and Medicaid are only permitted to pay claims for drugs that are prescribed for their approved use. When a doctor or pharmaceutical company prescribes or promotes a drug for an unapproved use, subsequent invoices for reimbursement could trigger False Claims Act liability.
June 29, 2015 Healthcare Fraud

Connecticut Doctor Settles Allegations of Medicare Fraud

In a small but mighty settlement against an experienced Connecticut physician, the Department of Justice recently exposed significant fraud and upcoding schemes within a Ridgefield office specializing in geriatric care. The physician, who has been practicing medicine for over 40 years, is alleged to have instructed his staff and billing […]
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