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August 2017 Archives

Whistleblower to receive over $2 million in False Claims Act case

A former employee of a mobile ophthalmic company blew the whistle on kickbacks being paid to potential doctor-clients. Sightpath Medical Inc., TLC Vision Corporation and their former CEO have agreed to pay $12 million to resolve the allegations, and the whistleblower will receive 19.5 percent of that settlement -- or $2,340,000.  The U.S. Government also intervened in an underlying lawsuit against the Cameron Ehlen Group, d/b/a Precision Lens, and its owner.

Lawsuit: Walgreens conspired with PBMs to charge the insured more

A Walgreens customer who was insured through Anthem Blue Cross Blue Shield has filed a federal class action lawsuit against Walgreens accusing it of conspiring to overcharge customers who have insurance. According to the lawsuit, Walgreens has secret agreements with a number of pharmacy benefit managers, or PBMs, which allow the pharmacy to charge the full copay to insured clients even though many drugs cost less than that copay -- and is sold at that lower price to people without insurance.  This is remarkably similar to a case successfully concluded by Ms. Fischer against CVS/Caremark.

United Healthcare accused of jacking up federal quality ratings

Two whistleblowers have accused United Healthcare Services Inc. of intentionally mishandling or concealing hundreds of complaints in order to jack up its quality ratings and get bonus payments it didn't deserve. United Healthcare Services runs the country's largest Medicare Advantage plan, and Medicare paid some $1.4 billion in quality bonuses last year -- compared to only $564 million in 2015.

Don't let a breach of contract be a breach on your finances

In business, contracts are a viable, commonly employed method used to protect the interests of two parties. When one party violates the terms of a business contract, it can result in serious legal and financial complications, and often, it takes a long time to resolve. If you or your New York business is suffering the ramifications of a breach of contract, you do not have to face it alone.

Justice Department forms first Health Care Fraud Unit

After last month's takedown of some 400 medical professionals accused of $1.3 billion in false billings, the Justice Department intends to remain vigilant in its fight against healthcare fraud. It has just announced the creation of the nation's first Health Care Fraud Unit to focus on issues like kickback schemes, upcoding and false diagnoses.

Wells Fargo to pay $577,500 to fired fake-account whistleblower

There has been a major development in the case of Wells Fargo and the harsh incentives it allegedly put in place to encourage its private bankers to open fraudulent accounts. A former branch manager in Pomona, California, was fired after she brought forward concerns about conduct that she reasonably believed constituted mail, wire and bank fraud to her superiors.

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