The Middle District of Florida convicted two men of a $1.4 billion health care fraud after a 24-day trial. They conspired to fraudulently bill private insurers using a sophisticated pass-through billing system where drug test analyses were reportedly conducted in...
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Healthcare Fraud
Hospitals face penalties for not making prices public
The Centers for Medicare and Medicaid Services (CMS) hit two hospitals in Georgia with $1.1 million in financial penalties for violating the 2021 rules requiring hospitals to share their medical procedures and treatment prices. This change (which the CMS will enforce)...
Feds bring suit against two company heads running 11 nursing facilities
The Southern District of New York and the U.S. Department of Health and Human Services have filed a healthcare lawsuit against 11 New York-based defendants. The lawsuit seeks damages and penalties for billing Medicare for unreasonable or unnecessary procedures at 11...
Home healthcare agencies settle claims of not appropriately paying staff
Two licensed home care services agencies in Brooklyn have settled claims of not appropriately paying their staff. The cases were heard in the Eastern District of New York. All American Homecare Agency and Crown of Life violated the federal False Claims Act and New...
Three healthcare fraud trends two watch for 2022
The pandemic stretched the health care system beyond its limits, causing waiting rooms to overflow with those trying to get treatment and hospital beds to be hard to come by. While things have settled down in the spring of 2022, the aftermath of the last few years...
Whistleblowers help DOJ recover billions
The Department of Justice recovered over $1.6 billion thanks to qui tam whistleblower lawsuits in the fiscal year 2021, which is October 1, 2020, to September 30, 2021. The qui tam provisions under the False Claim Act empower private citizens to file lawsuits on...
DOJ takes first case involving data mining
In September of 2021, the Justice Department accused a health insurer in upstate New York and an affiliated medical data analytics company of cheating the federal government out of tens of millions of dollars. The civil complaint of fraud is the first to target a data...
Health care system Pays $90 million settlement
Sutter Health recently settled allegations of mischarging the Medicare Advantage Program. The $90 million settlement is the second-largest settlement under the False Claims Act against a hospital provider, the second-largest in California. The settlement resolves a...
Gymnasts allege the FBI and others turned a blind eye on Nassar
Official USA Gymnastics physician Larry Nassar systematically abused hundreds of girls and women, and he was finally charged in 2016 with federal child pornography offenses and sexual abuse charges in Michigan. Nassar pled guilty in 2017, but gymnasts believe that...
These acts help protect healthcare whistleblowers
There are some general protections to whistleblowers, but the Patient Protection and Affordable Care Act adds specific protections for those in the healthcare industry. It specifically protects workers from retaliation if they report violations. The act defines...
