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health care fraud 35 articles

Whistleblower Sues Montana Hospital over Alleged Kickback Scheme

A newly unsealed whistleblower complaint against Kalispell Regional Healthcare accuses the Montana hospital of engaging in an extensive kickback scheme that put the profits of specialist physicians and hospital executives above patient care while defrauding U.S. and Montana taxpayers. The newly unsealed suit was originally filed in September 2016 by John Mohatt, formerly the CEO of Kalispell Regional Healthcare’s physician network. An amended False Claims Act complaint was filed in May of last year and remained under seal until recently, although the U.S. Department of Justice continues to investigate the whistleblower’s allegations, Kalispell’s Flathead Beacon reports. U.S. law prohibits hospitals ... Read More

Whistleblower’s Suit Against Roche, Humana Survives Motions to Dismiss

A whistleblower’s $45 million False Claims Act lawsuit alleging Humana and Roche Diagnostics engaged in an illegal kickback scheme and other health care fraud will stand after an Illinois federal judge rejected two motions to dismiss the allegations. Crystal Derrick, a former Roche account manager, filed the whistleblower complaint on behalf of the U.S. government in 2014, HealthPayer Intelligence reports. She alleges that Roche improperly dismissed debt Humana owed to Roche in a bid to keep Roche Diagnostic’s diabetes testing products on Humana’s formularies. The deal also helped bar competitor products from Humana’s formularies, the whistleblower complaint alleged. According to Louisville Business ... Read More

Health Quest Pays $14.7 million To Resolve Whistleblower Allegations

Health Quest Systems Inc. and one of its hospitals will pay $14.7 million to settle three whistleblower complaints filed under the False Claims Act alleging the New York-based hospital system and one of its hospitals submitted inflated and ineligible claims to Medicare for reimbursement. In the settlement announced by the U.S. Department of Justice, Health Quest and Putnam Health Center of Carmel Hamlet, New York “admitted, acknowledged, and accepted responsibility for certain facts involving the submission of improper claims for various health-related services,” the Justice Department said. The whistleblowers alleged that Health Quest submitted for evaluation and management services but ... Read More

Whistleblower Helps Medicare Recover $9.68 Million From Oxygen Supplier

Federal officials praised a whistleblower whose False Claims Act lawsuit against a Florida-based medical equipment supplier recovered $9.68 million for Medicare. U.S. Attorney Joseph Brown of the Eastern District of Texas said its multi-million-dollar settlement agreement with Rotech Healthcare Inc., a supplier of respiratory equipment and portable oxygen, resolves allegations that Rotech knowingly billed Medicare for portable oxygen supplies it provided to Medicare beneficiaries who didn’t need or use them. Rotech also admitted that it billed Medicare for oxygen supplies regardless of whether the supplies were delivered to beneficiaries. Medicare covers rentals of portable and stationary oxygen equipment for up ... Read More

Health Care Fraud Convictions Get Palm Beach Physician 3 Years

A Palm Beach, Florida physician who was convicted of profiting from a scheme of health care fraud that cheated Medicare and other federal health care programs out of millions of dollars was sentenced to three years in prison and a $200,000 fine. Dr. Gary Marder, a prominent osteopathic physician and well-known South Florida philanthropist, previously paid about $6 million to settle a related civil suit brought by a whistleblower under the False Claims Act. It was that case that federal investigators looked into and chose to press criminal charges against Dr. Marder. According to the Palm Beach Post, U.S. District ... Read More

UnitedHealth Group Loses Bid To Toss $1 Billion Whistleblower Case

A $1 billion whistleblower case against Minnesota-based UnitedHealth Group alleging the health care giant defrauded Medicare by wrongfully retaining overcharges can move forward, a federal judge in California ruled. UnitedHealth Group, the largest health care company in the world by revenue, had filed a motion seeking to dismiss the whistleblower lawsuit, which the U.S. government has investigated and actively supports. The lawsuit, filed by Former UnitedHealth Group finance director Benjamin Poehling in 2011, alleges UnitedHealth violated the False Claims Act when it allegedly submitted false information about patient conditions to Medicare to collect higher reimbursements. After a protracted investigation of ... Read More

Three Convicted in $4.3 Million Kickback Scheme Targeting TRICARE

The owner of a Florida pharmacy, a physician, and a patient recruiter have been convicted of criminal charges for their involvement in an illegal kickback scheme that cheated a taxpayer-funded health care program for active military members out of $4.3 million. According to the U.S. Department of Justice (DOJ), Larry Howard, 53, the owner of Fertility Pharmacy in Oviedo, Florida, paid illegal health care kickbacks to patient recruiter Raymond Stone, 57, of Orlando. Mr. Stone in return referred patients to doctors selected by Mr. Howard. Those doctors then prescribed expensive pain and scar creams to Tricare patients. The prescriptions were ... Read More

Long Island Radiology Chain Pays $10 Million to Settle Whistleblower Lawsuit and Criminal Penalties

A pair of billing specialists formerly employed by a Long Island radiology company helped the U.S. government and the State of New York recover more than $10 million through a False Claims Act lawsuit alleging systemic Medicare and Medicaid fraud. Whistleblowers Linda Gibb and Donna Geraci sued Zwanger-Pesiri Radiology on behalf of the U.S. government, accusing the company of overbilling the Medicare and Medicaid programs for a multitude of radiological services, including CT Scans, MRIs, and x-rays. Soon after joining Zwanger-Pesiri in 2010, Ms. Geraci discovered the company regularly falsified Medicare and Medicaid claims for service they provided that were ... Read More

DOJ indicts Chilcott exec on the heels of criticism it let Novartis leaders off the hook

The Department of Justice (DOJ) flew in the face of its critics last Thursday when it indicted W. Carl Reichel, former president of Warner Chilcott PLC’s pharmaceutical division, on charges of conspiring to pay kickbacks to physicians. The felony health care fraud charge was part of a False Claims Act (FCA) settlement agreement that also included $125 million in fines. The arrest may silence critics who last week accused the DOJ of breaking its vow to get tough against Big Pharma leaders when it let Novartis off the hook for an alleged illegal kickback scheme with a $390 million settlement, ... Read More

New York clinic owner admits to $55 million health care fraud conspiracy

Valentina Kovalienko, the owner of two medical clinics located in Brooklyn, N.Y., has pleaded guilty to committing up to $55 million in health care fraud by using fake vendors to pay illegal kickbacks. According to the Department of Justice (DOJ), Kovalienko is partially responsible for providing patients with medically unnecessary physical and occupational therapy, office visits and diagnostic tests from February 2008 through February 2011 to receive cash kickbacks from Medicare and Medicaid. In order to keep the secret safe, the DOJ says she also paid occupational and physical therapists on the side so they would falsify patient charts and ... Read More