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Showing 11 posts in Unnecessary Medical Services and Procedures.

Recent Supreme Court Ruling Gives Whistleblowers More Time

SCOTUS delivered a unanimous opinion on May 13, 2019 affirming a Eleventh Circuit ruling that (1) the extended limitations period of up to 10 years applies to whistleblower-initiated False Claims Act lawsuits in which the government has declined to intervene and (2) whistleblowers in nonintervened cases are not "the official of the United States" referred to by the statute. This decision resolved a three circuit split. 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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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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False Claims Act and the Opioid Crisis: First-ever Civil Injunction Filed by Justice Department to Combat Opioid Over-Prescription

In August 2018, the U.S. Department of Justice announced allegations against an Ohio doctor for violating the False Claims Act (FCA) in addition to violating the Controlled Substances Act (CSA) for prescribing opioid prescriptions in excessive amounts or to those who are not in need of the medication. Although an FCA case is not the most traditional approach to these issues, it is clear that the Justice Department is making the opioid crisis a top priority and therefore potentially invoking the FCA more often in these cases. The government's focus on the opioid crisis has been consistently increasing and expanding from targeting manufacturers of opioids to targeting prescribers and healthcare providers that submit claims to federal health care programs or to the federal government. 

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US Government continues to combat health care fraud in Chicago

Both the False Claims Act and criminal health care fraud laws continue to be powerful tools for combating health care fraud—and many criminal health care fraud cases could also have been FCA cases, had a whistleblower come forward in time. More

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The High Cost of Ambulance Fraud: Billing the Government for Unnecessary Services

Ambulance fraud takes many forms.  Sometimes ambulance companies charge Medicare or Medicaid for unqualified rides, miles or services; sometimes those charges are inflated; sometimes the rides are not even provided. In all of these cases, the ambulance company pockets the additional, undeserved money, and taxpayers end up paying more than they should. When the government pays out money to unscrupulous business owners, there is less money available to serve those truly in need of care. These frauds place a particularly heavy burden on our healthcare system and increase costs for everyone. More

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Billing for Unnecessary Services: False Claims Act Allegations Against 21st Century Oncology

Recently, 21st Century Oncology Inc. a provider of cancer care, and its subsidiary, South Florida Radiation Oncology LLC, settled a legal claim with the U.S. government, agreeing to pay $34.7 million to resolve allegations that the companies billed for unnecessary services and medical tests. More

Fraud and Cardiac Stents: When Doctors and Hospitals Use Stents for Financial Gain

Cardiac stents fraud

Patients trust doctors to have their best interests at heart when making recommendations about medical treatment and the appropriate course of action. Unfortunately, this isn’t always the case, and doctors and medical professionals sometimes recommend medical treatment and procedures that are not needed. In fact, according to this article in USA Today, unnecessary surgeries might account for 10% to 20% of all operations in some specialties, including a wide range of cardiac procedures and many spinal surgeries. More

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