Posts Tagged ‘Qui Tam’
Appeals Court Issues Precedential Ruling in Charitable Assistance Organization Kickback Case
The increase in enforcement activity related to donations made by pharmaceutical manufacturers to nonprofit patient charitable assistance organizations has resulted in a number of whistleblower or Qui Tam lawsuits. Those lawsuits have hinged on the idea that such donations may be viewed as illegal kickbacks because they could be seen as a means to steer…
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 MoreFailure to Repay Can Result in FCA Case
There’s nothing wrong with holding on to money for as long as you can before giving it back, is there? Well, if you’re a medical practice and you delay repaying overpayments owed to the government, then it can get you in some hot water. That’s what happened to First Coast Cardiovascular Institute, P.A., a Jacksonville,…
Read MoreGenesis Healthcare Settlement Another Example of Government’s Anti-Fraud Campaign
Whatever else is taking place in the nation’s capital these days, one thing is for certain, there is no letup in the government’s crackdown on healthcare fraud. This is made clear by the continued announcements of multimillion-dollar settlements coming from various fraud-fighting agencies. One of the more recent settlements involves Genesis Healthcare, Inc., a Kennett…
Read MoreFeds File False Claims Act Lawsuit Against UnitedHealth Group
Is it the government’s “murky policies,†as suggested by a UnitedHealth spokesman, or was it outright fraud that led to allegations the healthcare insurance giant engaged in fraud? That’s a question that will have to be answered following the U.S. Department of Justice’s recent decision to intervene and file a complaint against UnitedHealth Group (UHG).…
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…
Read MoreHow whistleblowers are helping to fight healthcare fraud
Earlier this month, the Department of Justice announced it had resolved a $237 million judgment against Toumey Healthcare System in South Carolina for violations of the Stark Law. In this particular case, the hospital was alleged to have entered into contracts with 19 specialists that required them to refer their outpatient procedures to the hospital…
Read MoreFederal prosecutors increasingly target individual healthcare execs in anti-fraud efforts
Last month’s sentencing of the former president and CEO of OtisMed Corporation to two years in prison should serve as yet another example that federal prosecutors are not holding back when it comes to holding corporate executives accountable. Charlie Chi was sentenced for intentionally distributing a medical device used in knee replacement surgery despite the…
Read MoreWhat happens if you become the target of a healthcare fraud investigation?
No healthcare provider wants to become the target of a healthcare fraud investigation. But, as we have seen, it happens more often than we would like to think. Not only does a healthcare fraud investigation come with the potential for criminal penalties, but the state also can impose harsh consequences resulting in the loss of…
Read MoreWhistleblower lawsuits: How to avoid becoming a target
Earlier this month, three former managers of AIDS Healthcare Foundation Inc. (AHF) filed federal and state Whistleblower Act claims against their former employer. They allege that the nation’s largest supplier of HIV/AIDS medical care participated in patient referral kickbacks to the tune of at least $20 million since 2010. All three plaintiffs held management positions…
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