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Las Vegas Doctor Arrested For Illegal Opioid Distribution

A Las Vegas pain management physician was arrested Tuesday, Feb. 13, and charged with 29 counts of unlawful distribution of a potent opioid drug and health care fraud. The U.S. Justice Department (DOJ) said it leveled the charges against Dr. Steven A. Holper, 66. Seven of the 29 charges allege the doctor prescribed the opioid Subsys (fentanyl sublingual spray), outside his professional practice to people who had no medical need for the drug. According to the DOJ, Dr. Holper “routinely prescribed Subsys for his patients without cancer.” The remaining charges involve Dr. Holper’s alleged false statements to Medicare and private health ... Read More

Whistleblower Warns Regulators of Stock Market Manipulation

The biggest index used by Wall Street to gauge stock market volatility, known as the Cboe Volatility Index or VIX, is being manipulated, causing wild market swings and costing investors hundreds of millions of dollars a month, an anonymous whistleblower has warned the Securities and Exchange Commission (SEC). The whistleblower, a senior executive who worked at many of the largest investment firms in the world, made the allegations in a letter to the SEC and the Commodity Futures Trading Commission (CFTC) sent by a Washington D.C. law firm. According to USA Today, the whistleblower alleges that the market manipulators are ... Read More

Aetna Denied Patients Coverage Without Reviewing Medical Records

An Aetna medical’s director’s stunning admissions that he never reviewed patient medical records before denying coverage has prompted an investigation by the Californian Insurance Commission. Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, said under oath that he never reviewed medical records before deciding whether to approve or deny coverage. According to CNN, Dr. Iinuma’s admission is the cornerstone of a lawsuit brought by 23-year-old college student Gillen Washington against Aetna. Mr. Washington accuses Aetna of breach of contract and bad faith, alleging the insurer denied him coverage ... Read More

Feds Ramp Up Efforts To Combat Opioid Fraud

As the nation’s opioid crisis continues to deepen, federal law enforcement authorities are concentrating their efforts on doctors and pharmacies that prescribe and dispense unusually large and disproportionate quantities of prescription opioid painkillers. Speaking at the U.S. Attorney’s office in Louisville, Kentucky, U.S. Attorney General Jeff Sessions said U.S. Drug Enforcement Administration (DEA) agents have launched a 45-day focused effort to gather and analyze opioid prescription and dispensing data. The patterns and statistical outliers that this data reveals will help DEA agents and other law enforcement authorities identify and crack down on the doctors and practices that are overprescribing and ... Read More

Whistleblower Lawsuit Ends in $16 Million Judgment Against Delaware MRI Operator

A whistleblower’s False Claims Act lawsuit against a Delaware MRI provider and its owner has resulted in a default judgment of more than $16 million. The U.S. Attorney’s Office for the District of Delaware said a Delaware federal court ruled on Jan. 29 that Orthopaedic and Neuro Imaging LLC (ONI) must pay $16,223,091, with the company’s owner, Richard Pfarr, personally liable for $6.12 million of that amount. Robin White, a former ONI employee, filed the whistleblower lawsuit on behalf of the U.S. government after she found that the company was submitting claims to Medicare for magnetic resonance imaging (MRI) scans ... Read More

DOJ In Damage Control After DC Lawyer Hawked Whistleblower Lawsuits

A promising Washington D.C. lawyer who admittedly stole and peddled sealed whistleblower lawsuits from the U.S. Department of Justice (DOJ), his former employer, is now cooperating with federal officials to help them prevent future False Claims Acts (FCA) cases and their relators from being jeopardized. Jeffrey Wertkin, a 41-year-old partner at Akin Gump Strauss Hauer & Feld, was busted in the lobby of a Cupertino, California, hotel last year trying to sell a sealed whistleblower complaint to an undercover FBI agent. The lawsuit was one of several False Claims Act complaints he illegally removed from the Justice Department before he ... Read More

Whistleblower Alleges Wichita Hospitals Cheated Medicare, Endangered Patients

A whistleblower lawsuit filed by a cardiologist under the False Claims Act (FCA) against a group of Wichita, Kansas hospitals and physicians was unsealed last week, revealing allegations that the defendants performed costly medical tests and procedures that weren’t medically necessary and subjected Medicare patients to undue risk. According to the Associated Press, the court unsealed the whistleblower lawsuit after the U.S Department of Justice declined to intervene in the case. Statements made by federal authorities, however, indicate that the lawsuit will likely proceed without the government’s participation. “The government’s decision to decline should not be construed as a statement ... Read More

Health Care Fraud Scheme Targeting TRICARE Ends in $7.6 Million Settlement

A California medical device company will pay the U.S. government $7.62 million to settle allegations it engaged in a health care fraud scheme targeting beneficiaries of TRICARE, the federal health care program for active-duty servicemembers and their families. The U.S. Justice Department lodged a False Claims Act (FCA) complaint against Vista, California-based DJO Global and its subsidiary Empi Inc. of Shoreview, Minnesota, alleging that the medical device manufacturers carried out a health care fraud plan involving the sale of special electrodes used for pain. According to the Justice Department, the medical device companies billed TRICARE for excessive and unnecessary transcutaneous ... Read More

Tennessee Chiropractor Settles Whistleblower’s Opioid Allegations

A Tennessee chiropractor who allegedly prescribed opioids with no legitimate medical purpose through his four pain clinics and then billed Medicare and Medicaid for them will pay the U.S. more than $1.45 million plus interest to settle the accusations, which were initiated by a whistleblower under the False Claims Act. The U.S. Department of Justice said that from 2011 through 2014, Lenior City chiropractor Matthew Anderson and his management company PMC LLC, which managed four now-defunct pain clinics, wrote opioid prescriptions for patients who had no legitimate need for them. The patients, many of them Medicare and Medicaid beneficiaries, had ... Read More

California Urologists Pay U.S. $1 Million to Settle False Claims Allegations

Two California urologists accused of submitting false claims to Medicare and causing other doctors to submit false claims to Medicare have agreed to pay the U.S. government more than $1 million to resolve the allegations. The U.S. Justice Department (DOJ) said that Dr. Aytac Apaydin and Dr. Stephen Worsham, who own and operate Salinas Valley Urology Associates in Salinas, California, “knowingly caused eight urologists in Monterey and Salinas, California … to violate the Anti-Kickback Statute and the Stark Law” through improper financial arrangements. The defendants also owned Salinas-based Advance Radiation Oncology Center, California, which dissolved in 2016. According to the False ... Read More