Posts Tagged ‘False Claims Act’
Lawsuit Alleges Cigna Upcoded Tens of Thousands of Medicare Advantage Claims
The U.S. Department of Justice has joined a whistleblower lawsuit accusing Cigna Corp. of overbilling Medicare Advantage by submitting false patient diagnosis information to inflate payments The lawsuit seeks damages and penalties under the False Claims Act. The whistleblower lawsuit originally was filed in 2017 in the United States District Court for the Southern District…
Read MoreCompounding Pharmacies to Pay $6.8M in Prescriptions-for-Money Scam
Three pharmacies and a billing company have agreed to pay more than $6.8 million to resolve allegations that they violated the False Claims Act by waiving co-pays, charging the government higher prices than allowed, and trading federal healthcare business with other pharmacies. Those implicated are: DermaTran Health Solutions, LLC; Pharmacy Insurance Administrators, LLC; Legends Pharmacy;…
Read MoreFeds Use Data Analytics to Detect Fraud
A Jacksonville-based healthcare provider accused of making false or fraudulent claims with the Florida Medicaid program agreed to pay $700,000 to resolve allegations it violated the False Claims Act. The case against Physicians Group Services resolves allegations that PGS submitted claims to Florida’s Medicaid program for quantitative urine drug testing that were medically unnecessary because…
Read MoreTexas MD Faces Significant Prison Time for TRICARE Fraud
A Texas physician faces significant time behind bars after being convicted of engaging in a scheme to fraudulently bill TRICARE, for toxicology and genetic tests that were not provided as represented and/or were medically unnecessary. TRICARE is the healthcare program for uniformed service members, retirees, and their families, Dr. Sekhar Rao, a vascular and interventional…
Read MoreAmerican Senior Communities Settles for $5.5 Million in FCA Case
Thanks to the work of a whistleblower, the U.S. Department of Justice recently settled with an Indiana-based skilled nursing and long-term care services company for $5.5 million to resolve allegations that it violated the False Claims Act. A former American Senior Communities (ASC) employee filed a whistleblower lawsuit in 2017 alleging that that ASC was…
Read MoreHealthcare Fraud Roundup
Medical Clinic Fraud The owner of a Miami-based medical clinic was recently sentenced to 60 months in prison for directing a $38 million healthcare fraud scheme. Armando Valdes also was ordered to forfeit four real estate properties, including a beachfront condo in Pompano Beach, as well as numerous luxury vehicles, including a Cadillac Escalade and…
Read MoreHealthcare Fraud Efforts Net $5B in FY 2021
The federal government’s crackdown on healthcare fraud resulted in more than $5 billion in judgments and settlements in Fiscal Year (FY) 2021, according to a new report from the U.S. Department of Health and Human Services and Department of Justice. It’s significantly more than the $3.1 billion recovered in FY 2020. As a result of…
Read MoreWatchdog Agency Details Enforcement Activities During Six-Month Period
The Department of Health and Human Services Office of the Inspector General (HHS-OIG) expects to make nearly $3 billion in recoveries resulting from the agency’s audits and investigations, according to its Semiannual Report to Congress released earlier this month. The semiannual reporting period runs from Oct. 1, 2021, through March 31, 2022. The watchdog agency…
Read MoreBilling Under Another’s Credentials Results in FCA Violation for Therapy Company
A Macon, Ga. rehab facility has been ordered to pay more than $9.6 million in damages after a district court judge ruled in favor of the government in a civil case alleging the fraudulent billing of hundreds of TRICARE and Medicaid claims. The order was the result of a judge’s recent ruling in which he…
Read MoreSix MDs Added to Laboratory Civil False Claims Case Filed in April
The U.S. Department of Justice has added six physicians to a Civil False Claims Act complaint it originally filed in April in a laboratory testing fraud case. According to the complaint, the Texas physicians received thousands of dollars in kickbacks in return for their referrals for laboratory testing. The original complaint was filed against two…
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