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Showing 16 posts in Medicare.

Carolina Physical Therapy and Sports Medicine, Inc. Settles False Billing Allegations and Agrees to Pay $790,000

US Attorney Sherri A. Lydon announced on May 9 that the United States Attorney's Office for the District of South Carolina has resolved claims of health care fraud with Carolina Physical Therapy and Sports Medicine, Inc. ("Carolina PT"). Carolina PT had nine physical therapy practices in South Carolina, in Columbia, Irmo, Lexington, Sumter, and Mount Pleasant respectively. More

Government Takes a Hard Line on Fraudulent Donations to Patient Assistance Programs

Last month, the Department of Justice ("DOJ") announced a settlement with two pharmaceutical companies – Astellas Pharma US, Inc. ("Astellas"), and Amgen Inc. ("Amgen") – resolving allegations that their "donations" to patient assistance programs violated the False Claims Act. The two companies agreed to pay a total of $124.75 million, and both entered into five-year corporate integrity agreements with the Office of Inspector General as part of their respective settlements. United States Attorney Andrew E. Lelling said that according to the allegations, the companies illegally subsidized the high costs of their own drugs at the expense of American taxpayers, and "[w]e will keep pursuing these cases until pharmaceutical companies stop engaging in this kind of behavior.” Multiple settlements related to similar investigations have already brought in hundreds of millions of dollars in only a few years' time. More

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Sutter Health Settles False Claims Act Allegations for $30 Million

Sutter Health, based in Sacramento, California, agreed to pay $30 million to settle allegations that the health system submitted inflated diagnosis codes to the Center for Medicaid Services (CMS) for Medicare Advantage beneficiaries.  The Department of Justice (DOJ) announced this in a press release on April 12, 2019.    More

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Durable Medical Equipment Provider Agrees To Pay $1.6 Million To Resolve False Claims Allegations

U.S. Attorney for Utah, John W. Huber, announced on December 11, 2018, that the durable medical equipment ("DME") company Western Medical Group agreed to pay $1,634,844 million to settle False Claims Act allegations.  The settlement is the result of two qui tam actions filed by whistleblowers in December 2013 and February 2014.  More

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Drug Maker Actelion Agrees to Pay $360 Million to Settle False Claims Act Investigation Into Kickbacks

The pharmaceutical company Actelion Pharmaceuticals US, Inc. ("Actelion"), based in South San Francisco, California, has agreed to pay $360 million to resolve claims that it illegally funneled kickbacks through a patient-assistance charity.  Federal prosecutors allege in a press release on December 6, 2018 that Actelion "illegally used a foundation as a conduit to pay the copays of thousands of Medicare patients taking Actelion's pulmonary arterial hypertension drugs." These actions are in violation of the False Claims Act.  More

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Medicare Advantage Provider to Pay $270 Million to Settle False Claim Act Liabilities

HealthCare Partners Holdings LLC, doing business as Davita Medical Holdings LLC (DaVita), has agreed to settle a False Claims Act liability case and will pay $270 million to the United States Government.  DaVita, headquartered in El Segundo, California, did not admit fault.  Relators allege that DaVita was providing inaccurate information that caused Medicare Advantage Plans to receive inflated Medicare payments.  More

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The Government Fights Back Against Ambulance Fraud: A Recent $21 Million Settlement and Other Related Cases

The U.S. Government has successfully combatted several instances of ambulance fraud this past year, by intervening in False Claims Act (FCA) qui tam suits and by pursuing a criminal health care fraud case against an ambulance company owner. These cases against AmeriCare, Hart to Heart, and the owner of Tonieann EMS and Rosenberg EMS, mainly involve allegations that these companies systematically billed government-provided insurance for medically unnecessary ambulance transports. However, a recently-resolved case against Paramedics Plus and several affiliates involved allegations of an illegal kickback scheme enacted to win and maintain exclusive ambulance contracts. More

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Walgreens Agrees to Settle Three Civil Fraud Lawsuits Totaling Over $270 Million

Walgreens Boots Alliance, Inc. ("Walgreens") has agreed to pay $269.2 million to settle two whistleblower lawsuits accusing it of overbilling federal healthcare programs for over a decade.  In both settlements, Walgreens "admitted and accepted responsibility for conduct the Government alleged in its complaints under the False Claims Act".  The U.S. Department of Justice made the announcement on January 22, 2019. In addition, Walgreens recently settled another False Claims Act claim, although the monetary value is modest in comparison with the first two.   In the third settlement, Walgreens agreed to pay $3.5 million to the U.S. and the State of Wisconsin to settle allegations that, from 2011 to 2014, Walgreens violated Wisconsin Medicaid rules by dispensing routinely stimulant medications to Wisconsin Medicaid beneficiaries without first verifying that the prescribing physician ordered the medication for a medically appropriate treatment.   More

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An Overview of Nursing Home Fraud: False Claims Act Cases from the Last Three Years

The last three years have seen several FCA cases related to nursing home fraud achieve success. Two cases of note—one against a skilled nursing facility chain and one against a rehabilitation therapy provider—settled for over $100 million, and a recent Third Circuit decision revived a dismissed case against a pharmaceutical company and narrowed the public disclosure bar. Still other cases involving similar allegations of inflating reimbursement levels and engaging in illegal kickback schemes have settled for millions or involved criminal prosecution of the individuals responsible. More

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Lincare Settles False Claims Act Allegations for $5.25 Million

Lincare, Inc., one of the nation's largest providers of durable medical equipment has paid $5.25 million to resolve allegations brought forth through a qui tam action filed by a Relator on behalf of the United States.  More

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