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January 2018 Archives

Whistleblower to receive $246,500+ in unnecessary opioids case

A former office manager for a Tennessee pain clinic filed a qui tam lawsuit under the federal False Claims Act accusing her former employer of falsely billing Medicare and TennCare for unnecessary painkillers, upcoding claims, and billing Medicare for improper nurse practitioner services. The federal government and the State of Tennessee brought suit and have just settled with a chiropractor, a nurse practitioner and several now-closed pain clinics. As a result of the whistleblower's actions, she will receive more than $246,500 -- a share in the total settlements.

Whistleblower to receive $225,000 in False Claims Act reward

San Diego-based Scripps Health, a health care system, has agreed to settle False Claims Act allegations for $1.5 million. According to the Department of Justice, Scripps Health violated the Act by billing Medicare and TRICARE for physical therapy services performed by un-enrolled therapists. A former employee blew the whistle on the unlawful billings against the two federal health programs, and she will receive a $225,000 reward in return for her service.

Former Wells Fargo insurance broker sued on non-compete agreement

Non-compete agreements serve an important purpose: To protect a company's interests after an employee departs. An issue involving non-compete agreements recently entered the news in New York.

DOJ: Production incentives led to false dental claims

The Department of Justice and a large number of states collaborated on a settlement with dental management company Benevis LLC and over 130 Kool Smiles dental clinics that Benevis provided services for. The clinics and Benevis have agreed to settle allegations of false claims made against state Medicaid programs. The companies allegedly submitted claims for medically unnecessary dental procedures, and procedures that were not performed, on Medicaid-insured children.

Pharmaceutical company to pay $210 million in FCA kickbacks case

Medicare beneficiaries are often required to make a copayment, use coinsurance or pay a deductible when buying prescription drugs. These are collectively referred to as "copays." Congress mandates certain copays, which rise with the expense of the drug, in order to introduce market forces into the purchase of prescription medications. Copays serve both to sway patient choices and to limit what pharmaceutical companies can charge for their drugs.

False Claims Act recovers $3.7 billion in the 2017 fiscal year

Health care fraud and false claims pose a serious financial threat to the federal government and tax payers alike. The Department of Justice (DOJ) works in conjunction with ordinary citizens and public servants to pursue justice against those committing the fraud.

Insurance coverage for fines and penalties for False Claims Act

Companies in New York routinely purchase directors' and officers' liability insurance to limit costs if someone's mistake or purposeful action triggers a lawsuit against the company. Litigation regarding securities or shareholder derivatives represents the primary concern of those buying D&O policies, but federal government contractors might also get into trouble under the False Claims Act.

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