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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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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, […]

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 […]

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 […]

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 […]

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 […]

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 […]