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The Case of the Bashful Whistleblower

William Nash filed a whistleblower case against his former employer but wanted to remain anonymous so that his new employer wouldn’t know that he is—you guessed it–a whistleblower. William’s qui tam action alleged Medicaid...more

How to Get a 2,333% ROI?

Three affiliated home health companies in Tennessee agreed to pay $1.8 million to settle False Claims Act (FCA) liability. That’s a lot of money, but it’s only about four percent of the $42 million in potential liability...more

Bad News for Whistleblowers: Defendant Pleads Guilty

At first glance, it looks nonsensical. How could it be bad news for False Claims Act whistleblowers that the defendant pleaded guilty to violating that statute—to committing the very Medicare fraud the whistleblowers alleged?...more

Achievements You Don’t List on Your Resume

A physician immigrated to the United States in 1991 and established a medical practice called Compassionate Doctors. By 2013 the practice and its related health care entities boasted some 44 employees and contractors,...more

Twelve-Year Sentence for Medicaid Diaper Scam

Maria Paz Garza was the King Midas of incontinence supplies: she turned diapers into dollars—over two and a half million of them, according to the government’s indictment. She did it through a scheme that charged Texas...more

Co-Winners of May’s Low-Return Fraud Award

We have a tie! Danielle Burroughs and Tim Arthur are co-winners of the Low-Return Fraud Award for the month of May. On May 30 a federal court ordered Danielle to pay a whopping $2.8 million in restitution for her role in a...more

New Medicare Fraud Defense: “My Mom Made Me Do It!”

Charged with 33 counts of Medicare fraud netting some $45 million in false claims, Richard Tinimbang invoked a novel defense: “My mom made me do it!” That, according to Law360, is the gist of the opening statement of...more

Far-Fetched Whistleblower Claim of the Month

The hospital industry is accustomed to far-fetched whistleblower claims: allegations that a hospital knowingly submitted false or fraudulent Medicare or Medicaid claims or fired a whistleblower for trying to prevent such...more

2016 Nerve-of-a-Burglar Award

Competition for the 2016 Nerve-of-a-Burglar Award was fierce, with health care providers constantly coming up with new and different ways to scam Medicare and Medicaid. Nevertheless, we have a clear winner: the Michigan...more

Biblical Name No Shield Against Fraud Charge

On May 2 a New Orleans federal jury found that Psalms 23 DME, LLC—its Biblical name notwithstanding–was part of a fraud scheme that illegally billed Medicare $3.2 million. In 2013 the government indicted Psalms 23 owner...more

Texas-Size Sentences for Texas-Size Medicare Fraud

They do things big in Texas. The latest example is the punishments being handed out for a Medicare fraud scheme at Riverside General Hospital in Houston. Let’s start with the fraud scheme. It was Texas-size, too,...more

The Downside of Being Number One

Americans are competitive. We generally think there’s nothing better than being number one—and not just at NCAA bracket time. But being number one isn’t always great. Just ask Dr. Michael Reinstein. He was the...more

Masked Man Robs Government; Faces 10 Years

The mask itself didn’t raise any suspicions. After all, the man wearing it—Richard Toussaint–was an anesthesiologist. But like so many other masked men, he turned out to be a thief. That’s why on March 4 he was convicted in...more

Criminal Conviction Leaves Defendant Defenseless in FCA Civil Action

Pity Dr. Christina Clardy. In 2011 she was convicted of health care fraud, sentenced to 135 months in prison, and ordered to pay $16 million in restitution. Then in 2014 the government added Christina as a defendant in its...more

Out of the Mouths of Babes: Millions of Medicaid Dollars

Last Monday the Office of Inspector General of Health & Human Services posted a hair-raising report. “Questionable Billing for Medicaid Pediatric Services in California” raises alarming questions about the billing practices...more

Hospital Fires Back: Accuses Whistleblowers of Violating Patient Confidentiality

Hospitals have long seethed over employees who exploit their inside information to become whistleblowers. There’s generally not much they can do besides seethe unless the employee has some special duty of confidentiality...more

It’s Risky to Bill Over 24 Hours in a Day

Remember the old joke about the lawyer standing at the pearly gates? He says he’s 52. St. Peter answers, “That’s strange. According to your time records, you’re 89.”...more

Orthopedic Patient Doesn’t Have a Leg to Stand On

It’s well known that Medicare, Medicaid and commercial insurers hate the ever-increasing trend of hospitals buying facilities and practices and then charging provider-based (i.e., higher) rates than the facilities and...more

U.S. Accuses NYC of Massive Fraud in Program for Developmentally Challenged Toddlers

It’s the city that never sleeps. So when it does something, it can do it in a big way. That applies to Medicaid fraud, according to a suit filed yesterday by the U.S. Attorney for the Southern District of New York....more

10/29/2014  /  Fraud , Healthcare , Healthcare Fraud , Medicaid

August Scam-of-the-Month Award

It turns out that back in 2011 the hospital sold the right to use its hospital billing codes to free-standing clinics. So under the arrangement, when the clinics sent bills, they were hospital bills rather than clinic bills...more

8/22/2014  /  Healthcare Fraud , Hospitals , Scams

Unnecessary Surgeries Put Hospital in Three-Front War

When the government accuses a hospital of committing Medicare fraud by billing for unnecessary surgeries, the hospital has a real problem on its hands. It’s at war with the government, and that’s expensive, as well as...more

What’s Scarier than a Compliance Officer Turned Whistleblower? A Whole Association of Them

In U.S. ex rel. Corporate Compliance Assocs. v. N.Y. Society for the Relief of the Ruptured & Crippled the court ruled that the whistleblower failed to meet the False Claims Act’s requirement that allegations be described...more

Finally, Some Good News for Halifax–And All Other–Hospitals

It’s been a long time since Orlando’s Halifax Hospital got any good news from the federal court hearing the whistleblower case brought by employee Elin Baklid-Kunz. Earlier this year the hospital had to agree to an $85...more

Halifax Health Gets In More Hot Water

You probably didn’t think Florida’s Halifax Health could make its situation any worse. After all, only two months ago Halifax agreed to pay $85 million to settle just the first half of a Medicare fraud case. That still...more

Kentucky Hospital Pays $41 Million To Settle Fraud Charges

Yesterday Kentucky’s largest hospital, King’s Daughters Medical Center, in Ashland, announced its agreement to pay $40.9 million to settle charges that it committed Medicare and Medicaid fraud by billing for coronary...more

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