Cancer is difficult enough to endure, with many uncomfortable procedures, without you or a loved one having to worry about undergoing unnecessary ones. But that’s exactly what it is alleged that 21st Century Oncology Inc., headquartered in Florida and the US’s biggest physician-led integrated cancer care provider, did in many cases. Adding insult to injury, 21st Century Oncology billed $34.7 million for these medically-unnecessary procedures. Continue reading
$34.8 Million Recovery for Alleged Medicare, Medicaid, and TRICARE Fraud
A sleep therapy products supplier, Respironics Inc., based in Pennsylvania, agreed to resolve charges of False Claims Act violations by paying $34.8 million because of a qui tam suit brought by a whistleblower. The agreement, announced in March 2016 by the U.S. Department of Justice, claims that kickbacks in the form of free call center services were paid by Respironics. These free services were supposedly given to durable medical equipment (DME) suppliers who bought sleep apnea masks from the Pennsylvania company during the period from April 2012 to November 2015. Continue reading
Cleaning Up the Environment—or Just Cleaning Up?
Environmental regulations are part of our lives, and rightly so. We need to keep from trashing our home, this planet, for ourselves and for future generations. A lot of time, effort, and money have gone into cleaning up old messes and preventing new ones, from the fossil fuels industry to nuclear plants. However, as always, the fraudsters are looking for opportunities. Continue reading
The Latest Government Trends in Whistleblower Actions
The Department of Justice (DOJ) has announced that, for all of fiscal year (FY) 2015, over $3.5 billion in settlements and judgments were obtained because of fraud cases against the government brought under the False Claims Act (FCA). This marks the fourth consecutive year that recoveries exceeded $3.5 billion. It was also the sixth consecutive year that over 700 new cases were brought under the FCA’s qui tam provisions, which allows whistleblowers (also known as relators) to bring false claims suits on behalf of the government and thereby share in any monetary recovery. Continue reading
Multi-Millions Medicare Fraud Takedown
In the largest series of arrests for Medicare fraud to date, 243 health care workers—including 46 doctors, nurses, and other licensed medical professionals—were nabbed in a nationwide sweep. The Medicare Fraud Strike Force, which includes personnel from the FBI, the Department of Health and Human Services (HHS), the Department of Justice (DOJ), and local law enforcement organizations, led the takedown in 17 areas over the course of three days. It is alleged that the health care professionals generated roughly $712 million of fraudulent Medicare billings. Continue reading
SC Student Loan Whistleblower Case Judgment of Over $9 Million
Educational loan abuse and fraud are starting to see their share of whistleblowers bringing cases under the False Claims Act (FCA). Student loans taken under dubious circumstances have become multi-million-dollar moneymakers at for-profit schools like ITT and the University of Phoenix.
In February, 2016, the US District Court of South Carolina awarded a default judgment of $9,283,123 against Lacy School of Cosmetology and its president, Earnest “Jay” Lacy, for false claims involving the US Department of Education and federal student loans and grants. The suit was filed under the qui tam provisions of the FCA, which enables private citizens to bring civil actions on behalf of the government and to receive a share of the recovery. Continue reading
Medicare Whistleblowers Split $3.5 Million
Two whistleblowers—a cardiac nurse and a healthcare consultant—are sharing more than $3.5 million, which is their portion of a $23 million qui tam False Claims Act settlement. The case, which was resolved mid-February of 2016, involved 51 hospitals that allegedly disobeyed Medicare rules regarding coverage of implanting heart defibrillation devices.
The hospitals in 15 states were allegedly charging for implanting cardioverter defibrillators, or ICDs, in patients who weren’t supposed to receive them under certain rules. An ICD functions similarly to an external defibrillator, delivering a shock to the patient’s heart when an abnormal heart rhythm is detected. The difference is that the ICD is small enough to be implanted in the chest, near the heart. Only patients who have specific health characteristics and risk factors are eligible for ICD reimbursement under Medicare rules. Each pocket-watch-sized device costs about $25,000. Continue reading
Recent False Claims Act Wins in South Carolina
On December 3, 2015, the District of South Carolina’s U.S. Attorney’s Office announced that it had collected over $7 million during fiscal year 2015 for U.S. taxpayers in various criminal and civil cases. In criminal actions, roughly $4.4 million was received, while for civil actions, the amount was almost $2.7 million. Most of the $7 million collected came from False Claims Act and whistleblower actions. Continue reading
A Dramatic Upswing of Whistleblower Disclosures by VA Employees
Whistleblower cases involving the Veterans Administration (VA) took a significant upturn in fiscal year 2015, according to the Office of Special Counsel (OSC). Although it is small—with only 140 employees—and independent, the agency’s job is to protect whistleblowers and other federal employees from prohibited personnel actions. The OSC’s 2015 whistleblower disclosures rose 56 percent from 2014, for a total of 755 disclosures for the fiscal year. A large amount of the increase is the result of a waterfall of new cases from the VA. Continue reading
Getting Taken for a Ride
When you think of Medicare fraud, ambulance services might not come to mind. After all, in a life-threatening situation, you’re going to call 911 for an ambulance. You’re not going to think about kickbacks, unnecessary procedures, upcoding, and other deceitful practices happening in the ambulance industry. And yet, ambulance fraud is big business for some Medicare suppliers. Continue reading