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criminal 188 articles

Whistleblower helps U.S. recover more than $5 million from medical device manufacturer

A whistleblower who sued his former employer, medical device manufacturer EndoGastric Solutions Inc., under the U.S. False Claims Act will receive nearly $1 million for his role in exposing alleged fraud at the company and helping the U.S. recover millions in government health care funds. EndoGastric Solutions agreed to pay the U.S. up to $5.25 million to resolve allegations that it misled health care providers about how to bill taxpayer-funded health care programs for using a device called EsophyX, which it manufactures. The device is designed to treat gastroesophageal reflux disease in a less invasive way than other procedures, which ... Read More

whistleblower lawsuit accuses major hospital chain of illegal kickback scheme

The Justice Department said the U.S. government has taken over a lawsuit brought by a whistleblower under the False Claims Act against two of the nation’s largest hospital owners and operators, alleging the companies devised a highly profitable kickback scheme that involved recruiting undocumented expectant Hispanic women and charging Medicaid for their medical care. According to the lawsuit, four hospitals in Georgia and South Carolina owned by Tenet Healthcare Corp. of Dallas, Texas, and a hospital in Monroe, Ga., owned by Health Management Associates, Inc. (HMA) paid kickbacks to obstetric clinics serving primarily undocumented Hispanic women in return for referral ... Read More

2014 expected to be another giant year for whistleblower bounties

With just five weeks of the new year past, there are already some strong indications that 2014 could be a huge one for corporate whistleblowers, according to a Wall Street Journal analysis. Government regulators are expecting several big whistleblower rewards this year, thanks to a number of critical fraud cases pending in U.S. courts. Many corporations that habitually took advantage of taxpayers and government programs in the past are still “grappling with how to handle employees who report wrongdoing,” the Wall Street Journal reported. A record number of qui tam lawsuits were filed by whistleblowers under the federal False Claims Act in ... Read More

Kentucky hospital settles whistleblowers’ fraud allegations for $16.5 million

A group of whistleblowers who filed a complaint under the U.S. False Claims Act against a Kentucky hospital system was instrumental in helping the federal government recover millions of dollars that were allegedly taken from it in schemes to defraud Medicare and Kentucky Medicaid programs, the U.S. Justice Department said. Saint Joseph Health System Inc. has agreed to pay $16.5 million to resolve the whistleblowers’ allegations that it charged the government health care programs for medically unnecessary cardiac procedures in an effort to boost profits – a scheme that amounted to the submission of millions of dollars in false claims. ... Read More

Federal grand jury investigating reports of fraud and abuse at Millennium drug-testing company

A federal grand jury in Boston is investigating allegations of health care fraud and employee intimidation against Millennium Laboratories of San Diego, Calif., a company that tests urine samples for the presence of pain medications. Millennium is one of a few companies in a relatively new industry of selling urine-testing services to pain clinics and doctors throughout the U.S. A growing number of health care providers rely on such services to test patients for painkillers before prescribing new drugs that can have potentially harmful interactions with painkillers the patient may already be taking. The services help health care providers monitor ... Read More

Abbott loses fight to have whistleblower’s TriCor lawsuit tossed

PHILADELPHIA–A Pennsylvania federal judge has refused to throw out a whistleblower’s claims that Abbott Laboratories submitted false claims to Medicare and other government health care programs and engaged in an illegal scheme of paying kickbacks to doctors in an effort to boost sales of its cholesterol drug TriCor. Illinois-based drug giant Abbott Laboratories took legal action year seeking to have the lawsuit dismissed on the basis that its allegations were not specific enough. U.S. District Judge C. Darnell Jones disagreed with those assertions, saying that the complaint, filed by former Abbott sales representative Amy Bergman under the U.S. False Claims ... Read More

Whistleblowers helped U.S. recover billions for Medicare, other programs in 2013

The number of whistleblower lawsuits filed under the False Claims Act, which allows individuals to sue on behalf of the U.S. government, soared to 752 in fiscal year 2013 and helped the government recover nearly $4 billion in settlements and civil judgments, the U.S. Justice Department said. It was the second largest annual recovery in history. The Justice Department said that 2013 was the fourth consecutive fiscal year in which whistleblower recoveries topped $3 billion. Fiscal year 2012 marked the largest amount of recovered funds to date, with nearly $5 billion in settlements and civil judgments. Most false claims actions ... Read More

Doctors who habitually defraud Medicare face fines, expulsion under new U.S. law

Doctors who habitually overcharge Medicare for care and services they provide to older patients will face civil fines and could be booted altogether from all federal health care programs, thanks to a new Centers for Medicare and Medicaid Services (CMS) directive that took effect Jan. 15. According to the New York Times, CMS administrator Marilyn Tavenner “indicated that the agency was losing patience with habitual offenders” and had issued new steps to identify and punish “recalcitrant providers.” The CMS defines a recalcitrant provider as one who is “abusing the program and not changing inappropriate behavior even after extensive education to ... Read More

Tennessee clinics settle whistleblower’s allegations of fraud for $1.85 million

Two Tennessee orthopedic clinics will pay a combined $1.85 million to settle a whistleblower’s allegations that the clinics engaged in a scheme to defraud Medicare by buying potentially unsafe injections of knee pain medication from foreign sources at deeply discounted prices, re-importing them for use in U.S. patients, and billing state and federal health care programs for the drugs at higher U.S. rates. The U.S. Justice Department said that Tennessee Orthopaedic Clinics P.C., headquartered in Knoxville, Tenn., will pay $1.3 million to settle the lawsuit, and Appalachian Orthopaedic Clinics P.C., headquartered in Kingsport, Tenn., will pay $550,000. The lawsuit alleged ... Read More

Whistleblower’s False Claims lawsuit leads to $30-million settlement with therapy providers

A whistleblower who sued a group of contract therapy providers under the False Claims Act will receive $5.6 million for helping the government recover $30 million in Medicare funds, the U.S. Justice Department announced Tuesday. The whistleblower sued RehabCare Group Inc., RehabCare Group East Inc., Rehab Systems of Missouri, and Health Systems Inc., alleging the companies devised and participated in a kickback scheme that put profits ahead of patient care. According to the lawsuit, between March 1, 2006 and Dec. 31, 2011, RehabCare and Rehab Systems of Missouri arranged a deal in which RehabCare would acquire Rehab Systems of Missouri’s patient ... Read More