News & Analysis as of

Whistleblowers Medicare

Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

by Ruder Ware on

Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more

The Siege Continues: The Justice Department is Investigating Four Additional Medicare Advantage Plans

In our prior blog post, we reported that, at the request of the federal Department of Justice, the FCA qui tam whistleblower lawsuit in the case of United States ex rel Benjamin Poehling v. United HealthGroup, Inc., et. al....more

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against...more

Alleging Improper Use of Funds Legitimately Obtained from the Government Insufficient to State FCA Retaliation Claim

by Dorsey & Whitney LLP on

The U.S. District Court for the Southern District of Texas has dismissed an FCA retaliation claim brought by a nurse who claimed to have blown the whistle on misuse of funds at a hospital that received significant federal...more

Healthcare Law Update: December 2016

by Holland & Knight LLP on

Prompt Payment Discounts Not an Anti-Kickback Statute Violation - In United States of Am. et al. ex rel. Ruscher v. Omnicare, No. 15-20629, 2016 WL 6407128 (5th Cir. Oct. 28, 2016), the court of appeals affirmed summary...more

The Difference between Expecting Referrals & Inducing Them

by Faegre Baker Daniels on

A new Fifth Circuit opinion explains the difference between offering a benefit in order to induce a Medicare referral and offering it in the expectation of a referral. The difference is important because the former is a...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

by King & Spalding on

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

Drug Companies and Charitable Patient Foundations

by Michael Volkov on

Charitable organizations can easily become enmeshed in Justice Department enforcement issues. We have seen charities used in FCPA cases as a means to funnel bribes to government officials, spouses or family members....more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: August 2016

by Mintz Levin on

Since our last issue, we have identified 31 recently unsealed health care-related whistleblower cases. In this Qui Tam Update, we analyze the trends and take an in-depth look at a few noteworthy cases....more

Check Up on Healthcare Fraud Prosecutions

by Michael Volkov on

Chief compliance officers face an overwhelming level of risk in the healthcare sector. I do not mean to belittle the risks of corruption, AML, sanctions and other risks typically associated with global companies. Healthcare...more

When Inside Knowledge Is a Handicap to a Whistleblower

by Faegre Baker Daniels on

Here’s a riddle: The whistleblower is a former employee of the defendant, with inside knowledge of the operations at the heart of his qui tam suit. How can that inside knowledge be a handicap in pressing his claim? A June...more

Jury Sides with Defendant in Whistleblower's Suit Alleging Defendant "Caused" False Claims

by Baker Ober Health Law on

Abbott Laboratories recently won a jury verdict in a high profile qui tam lawsuit alleging that Abbott “caused” health providers to submit false Medicare payment claims for off-label use of biliary stents. U.S. ex rel....more

Court Dismisses Major False Claims Act Case Against Hospice Provider: Ruling Mere Difference of Medical Opinion is Insufficient...

On March 31, 2016, the United States District Court for the Northern District of Alabama in U.S. ex rel. Paradies v. AseraCare, Inc. dismissed a major False Claims Act case against a national hospice provider after ruling...more

OK to Exaggerate How Long Patients Need Device

by Faegre Baker Daniels on

Today’s riddle: Why would a federal court approve a medical device manufacturer’s practice of persuading physicians to exaggerate the period of time Medicare patients need their devices? The answer is so simple that you’ll be...more

A Grossly Negligent Claim Isn’t a False Claim

by Faegre Baker Daniels on

You have to feel sorry for whistleblower Darilyn Johnson. The former billing clerk thought she had a sure-fire, double-barrel False Claims Act (FCA) case against the medical clinic that fired her. Barrel one was her...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: December 2015

by Mintz Levin on

Trends & Analysis - We have identified 24 health care–related qui tam cases that have been unsealed since our last Qui Tam Update. Of the 24 cases, five were filed within the past year, seven were filed in 2014, three...more

California Court Permits FCA Claim Involving Medicare “Referral and Regeneration” Scheme to Proceed Against Healthcare CEO

by Dorsey & Whitney LLP on

In a recent opinion, the Northern District of California allowed FCA claims to proceed against the CEO of a skilled nursing facility operator. John Orten, the whistleblower in the suit, was a former nursing home...more

Millennium Health to Pay $256 million in False Claims Act Settlement

by Polsinelli on

Millennium Health, one of the nation’s largest urine drug testing laboratories, has agreed to pay the government $256 million to resolve claims that it violated the Federal False Claims Act (“FCA”). The Settlement...more

PE-Backed Lab Company Millennium Health to Pay $256 Million Settlement with Government

by McGuireWoods LLP on

We’ve discussed in the past certain risks of which investors should be aware with laboratory investments. Last week, TA Associates portfolio company Millennium Health agreed to pay $256 million to resolve claims that it...more

Corporate Investigations & White Collar Defense - October 2015

"Wherefore Art Thou Due Process?" Part III - Why it matters: It is time for another installment in our continuing "Wherefore Art Thou Due Process?" coverage into the ongoing constitutional challenges to the SEC's...more

Foreign Corrupt Practices Act 2015 Update

by BakerHostetler on

Despite a decline in enforcement actions by the Securities Exchange Commission (“SEC”) and the Department of Justice (“DOJ”), the first half of 2015 has continued to highlight the relevance and ever-evolving effects of the...more

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases: October 2015

by Mintz Levin on

Trends & Analysis: ..We have identified 15 health care–related qui tam cases that were unsealed since our last Qui Tam Update. Of those, 12 were filed from 2012 to the present. All but two cases had been pending more...more

Fourth Circuit Grants Review of Use of Statistical Sampling in False Claims Act Case to Prove Liability and Damages

by King & Spalding on

On September 29, 2015, the United States Court of Appeals for the Fourth Circuit agreed to hear on interlocutory appeal the controversial issue of reliance on statistical sampling in a whistle-blower action to prove liability...more

Health Law Pulse - October 2015

by Robinson & Cole LLP on

The Health Resources and Services Administration (HRSA) recently issued proposed omnibus guidance (Omnibus Guidance) interpreting various provisions of the 340B Drug Pricing Program (340B Program). The 340B Program allows...more

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