Posts Tagged ‘Medically necessary’
Lab Owners to Pay $13.6M in False Claims Act Whistleblower Case
A Missouri laboratory and its three owners have been ordered to pay more than $13.6 million to settle charges they violated the False Claims Act – the federal government’s primary tool for civil enforcement. Jerry, Jerrod and Joel W. Murphy, owners of Gamma Healthcare Inc., were accused of submitting false claims to Medicare for lab…
Read MoreFinancial Advisor Guilty in Far-Reaching Compound Pharmacy Fraud
compound pharmacy fraud
Read MorePharmacy Owner Pleads Guilty to $8.3M Fraud Scheme
A Fort Lauderdale man who invested in three pharmacies that participated in the Medicare program pleaded guilty to taking part in an $8.3 million fraud scheme. According to court documents, Michael Murphy, 37, invested in Cure Pharmacy in Jacksonville and two other pharmacies. From around November 2019 until March 2021, he and his co-conspirators engaged…
Read MoreUM to Pay $22M to Settle Whistleblower Lawsuits
The University of Miami recently agreed to pay $22 million to settle three whistleblower lawsuits alleging violations of the False Claims Act. The cases were first filed between 2013 and 2014. The government alleged that UM knowingly engaged in improper billing relating to its hospital facilities. Medicare regulations allow medical systems to convert physician offices…
Read MoreProviders Beware: Ensure That Diagnostic Tests are Medically Necessary!
A fundamental principle of providing healthcare services to Medicare beneficiaries is that the services must be “medically necessary,†which means that they must be “reasonable and necessary for the diagnosis or treatment of illness or injury.†42 U.S.C. § 1395y(a)(1)(A). This requirement also imposes an obligation on healthcare providers to ensure that health services ordered…
Read MoreSettling FCA Claim From the Great Beyond
Just because you die, it doesn’t mean you can’t be held accountable for illegal activity conducted while you were still alive, as evidenced by a recent settlement agreement announced by the U.S. Department of Justice. The U.S. Attorney for the Middle District of Orlando, in late January, announced that the estate of Dr. Patrick T.…
Read MoreProsecutors Target “Drug Dealers in Lab Coats”
The first few weeks of the new year have seen a high number of healthcare professionals who have pleaded guilty, were convicted or sentenced on charges relating to the illegal prescribing of narcotics, including one who prosecutors described as “the latest drug dealer in a lab coat.†The cases are tied to an ongoing crackdown…
Read MoreCourt Reverses itself (in Part) in Laboratory Testing Case
A federal court judge in the District of Columbia has reversed his previous ruling that found Boston Heart Diagnostics Corp. was legally obligated to ensure the medical necessity of tests when submitting claims to Medicare. However, U.S. District Judge Reggie B. Walton did not go so far as to toss the lawsuit entirely, stating that…
Read MoreLessons learned from whistleblower FCA case against cancer treatment company
Earlier this month, the U.S. Department of Justice announced that 21st Century Oncology and its wholly owned subsidiary, South Florida Radiation Oncology LLC, agreed to settle False Claims Act allegations relating to billing for procedures that were medically unnecessary. Specifically, the Fort Myers, Florida-based company was alleged to have billed for performing the Gamma function…
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