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Posts tagged "Medicare/Medicaid Fraud"

DOJ: Alere Inc. knowingly sold unreliable diagnostic devices

A former Alere Inc. employee who blew the whistle on the medical device manufacturer will receive approximately $5.6 million as a reward. The former senior quality control analyst exposed millions of dollars in false claims against Medicare, Medicaid and other federal healthcare programs.

U.S. Attorney settles False Claims Act case with hospice provider

A private, for-profit hospice provider and its CEO have agreed to settle False Claims Act allegations brought by the federal government. The company and its head have agreed to pay $1,240,000 to resolve claims that they fraudulently billed Medicare and Medicaid.

Imaging group to pay $16.2 million in False Claims Act judgment

Orthopaedic and Neuro Imaging LLC (ONI) and its owner were accused of submitting some $6,125,947.13 in false claims to Medicare. A default judgment has been issued against them. Generally, a default judgment is entered when defendants fail to defend themselves in court.

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.

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.

Whistleblower claim yields 6-state, $33-million fraud settlement

Seven years ago, two doctors stood up to powerful players in the emergency medical field by blowing the whistle on Medicare fraud. Their courage and hard work contributed to settlements of more than $33 million between two large physician groups and the Justice Department. As a result, the two whistleblowers will receive over $6.2 million.

Oncology providers to pay $26 million in False Claims Act case

Florida-based 21st Century Oncology provides integrated cancer care. It owns and operates affiliates and subsidiary clinics throughout the U.S., with doctors specializing in fields such as medical oncology, radiation oncology and urology. It has just settled two cases with the Justice Department for $26 million.

Progressive units agree to $2 million False Claims Act settlement

A whistleblower will receive more than $600,000 after federal authorities obtained a $2 million+ settlement from Progressive Insurance in relation to alleged Medicare and Medicaid fraud. Progressive Casualty Insurance Co., of Cleveland, Ohio, and Progressive Garden State Insurance Co., of West Trenton, New Jersey, improperly submitted claims under the company's "health first" auto insurance policies.

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