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Defense Contractor Hit with Potentially More than $100 Million in Damages Following Huntsville Jury Verdict
A recent Huntsville jury verdict is sending a clear message to defense contractors across the nation: fraudulent defense contracts with the U.S. are likely to result in harsh consequences. On September 24, 2021, a federal court jury found a defense contractor liable for fraudulently inducing the U.S. Army into military contracts with Saudi Arabia, El
Telemedicine Fraud — Notable Cases and the Role of the Whistleblower
Not only has the use of telemedicine risen to unprecedented levels during the Covid-19 pandemic, but the Centers for Medicare and Medicaid Services (CMS) decided to relax Medicare coverage rules regarding telemedicine last year. As a result, telemedicine represents a relatively uncharted frontier in the health care industry, offering hopes of increased access and care
Opportunities for Medicare Fraud Abound in Telemedicine; Qui Tam Whistleblowers Cases Will Likely Increase
During the Covid-19 pandemic, the number of Medicare fee-for-service (FFS) beneficiaries using telemedicine skyrocketed by 13,000%, according to CMS administrator Seema Verma. In fact, during a single three-month span in 2020, over 9 million Medicare FFS beneficiaries utilized some form of telehealth services. While the opportunity for increased medical access afforded by telemedicine is great,
Recent Healthcare Fraud Developments — September 2021
Medicare fraud is as prevalent as ever, with billions of taxpayer dollars lost each year. However, recent developments show that the Department of Justice (DOJ) has renewed its emphasis on aggressively pursuing healthcare fraud through the False Claims Act (FCA) and recovering tens of millions of dollars in settlements for whistleblowers. Bayada Settles FCA Lawsuit
Sutter Health to Pay $90 Million in Record Medicare Advantage Whistleblower Settlement
Sutter Health, the largest hospital system in Northern California, agreed last week to pay $90 million to settle recent allegations of Medicare Advantage fraud. This is the second largest Medicare Advantage fraud settlement ever reported and the largest such settlement brought under the False Claims Act. Between 15-30% of this amount will go to the
Billing Fraud Recent Developments
Oglethorpe Inc. and Cardiologist Dinesh Shah settle billing fraud claims brought through the False Claims Act.
athenahealth and Biogen Anti-Kickback Settlements
The Depart of Justice shows commitment to combatting healthcare fraud through recent multi-million settlments with companies Athena and Biogen.
UNDERSTANDING THE ASERACARE CASE & MEDICAL NECESSITY
AseraCare is facing a whistleblower lawsuit from the US Government based on the False Claims Act. This case could set a precedent for future qui tam FCA cases, and to understand its impact we first need to understand the case itself.
ELEVENTH CIRCUIT COURT OF APPEALS RULES ON LACK OF MEDICAL NECESSITY CASES
In United States v. AseraCare, whistleblowers and government prosecutors obtained a substantial partial verdict against AseraCare, a for-profit home hospice company. The Government argued, and the jury agreed, that AseraCare was deliberately enrolling and billing Medicare for patients who were not eligible for hospice care. The district court, however, ultimately granted summary judgment in favor of AseraCare.
BEAVER MEDICAL GROUPS PAYS $5 MILLION TO SETTLE ALLEGATIONS OF MEDICARE ADVANTAGE FRAUD
Whistleblowers exposed Beaver Medical Group, L.P. for fraudulently misrepresenting its patients’ diagnoses to make them appear sicker in order to receive greater compensation. Ultimately, they agreed to pay the Government over $5 million and the whistleblower received $850,000. However, there was no determination of liability.