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Feds Unravel Multimillion Dollar Health Care Fraud Scheme Targeting New Jersey State Health Benefits Programs

August 21, 2017 - Thus far, five men, including an Atlantic City firefighter and four pharmaceutical sales representatives, have admitted to defrauding two New Jersey state health benefits programs of over $25 million by submitting fraudulent claims for compounded medications. More indictments may follow as the government continues its investigation into the conspiracy. The alleged [...]

Client Alert – Attorney General Sessions Announces Formation of Opioid Fraud and Abuse Detection Unit

August 8, 2017 - While speaking at the Columbus, Ohio, Police Academy last week, U.S. Attorney General Jeff Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit. The Unit is a pilot program, staffed by 12 U.S. Attorneys in select federal districts, that is designed to utilize sophisticated data tracking to detect and [...]

Client Alert – United Healthcare Named in Whistleblower Suit – Accused of False Reporting to CMS

August 7, 2017 - United Healthcare Services Inc., which operates the country’s largest private Medicare Advantage insurance plan (covering about 3.6 million people), has been accused by some of its own sales agents of concealing hundreds of complaints of enrollment fraud and other misconduct. The company is currently embroiled in an earlier lawsuit, filed in May, [...]

Client Alert – PBMs are Targets in Nevada’s Diabetes Drug-Pricing Transparency Bill

July 31, 2017 - In the absence of federal action, Nevada, along with a number of other states, is enacting legislation to combat skyrocketing drug prices and create transparency regarding the pricing activities of drug manufacturers and Pharmacy Benefit Managers (PBMs). Nevada’s Senate Bill 539 places new reporting requirements on pharmaceutical manufacturers and PBMs for [...]

Three Ohio Healthcare Companies Hit with $19.5 Million Price Tag for Medicare False Claims

July 19, 2017 - Three Ohio-based companies, Foundations Health Solutions Inc. (FHS), Olympia Therapy Inc. (Olympia), and Tridia Hospice Care Inc. (Tridia), along with two company executives, Brian Colleran (Colleran) and Daniel Parker (Parker), will pay nearly $19.5 million to settle allegations that the companies submitted false claims for medically unnecessary rehabilitation therapy and hospice [...]

DOJ Announces Nationwide Health Care Fraud “Takedown”

July 14, 2017 - In a statement issued yesterday, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price announced the largest-ever health care fraud enforcement action engaged in by the Medicare Fraud Strike Force.  The scams totaled approximately $1.3 billion. Overall, 412 people, including 115 doctors, nurses, and other [...]

Reining in Medicare Costs: New Facilities Fees Rule is now in Effect

Under Medicare rules in effect since 2000, hospital systems have been permitted to charge so called "facility fees" on top of their normal charges for professional care based on where the care took place. Reports issued in both 2012 and 2014 by the Medicare Payment Advisory Commission (MedPAC) found that Medicare often pays double for [...]

Feds Employ New Tactic in Battle against Health Care Fraud – Allege Violation of the “Travel Act” Executives, Surgeons, and Others Indicted in Texas in Massive Health Care Fraud Scheme

In December of 2016, 21 individuals, including the founders and investors of a physician-owned medical center in Dallas, Texas, were indicted by a grand jury and charged with an assortment of felony offenses stemming from their payment and/or receipt of over $40 million in bribes and alleged kickbacks. The now defunct operation, Forest Park Medical [...]

Hospice Companies Caught in Kickback Scheme, Pay $12 Million to Settle Allegations

Last month, we issued a client alert on the rising number of fraud, waste, and abuse cases being seen in the hospice care industry. Today we provide yet another example of the rising tide of hospice-related fraudulent schemes that the government is actively uncovering and prosecuting. This past Tuesday, the U.S. Attorney's Office, Northern District [...]

Former WellCare Executives Agree to Restitution and Civil Payments $ 26 million settlement wraps up Medicaid fraud case

In 2013, two former WellCare Health Plans Inc. executives (WellCare) were found guilty of health care fraud for their parts in devising and carrying out a fraudulent scheme that deceived the Florida Agency for Health Care Administration (AHCA), the Florida Healthy Kids Corporation (Healthy Kids), and WellCare's investors by retaining over $40 million in health [...]