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healthcare 187 articles

Whistleblower Accuses CVS Caremark of Medicare Drug Pricing Fraud

A recently unsealed lawsuit filed by a whistleblower against CVS Caremark accuses the corporation of overcharging Medicare and Medicaid for prescription drugs. The bombshell lawsuit could potentially return hundreds of millions of dollars in taxpayer funds to the government health care programs if the whistleblower’s False Claims Act allegations hold up in court. Sarah Behnke, who worked as an actuary for Aetna, claims CVS Caremark was good at negotiating lower prices with drug manufacturers as Aetna’s pharmacy benefit manager, but it did not pass those savings on to the government. The purpose of having companies such as Aetna, which provides ... 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

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

Scripps Health Settles Whistleblower Complaint for $1.5 Million

A whistleblower who sued San Diego health care system Scripps Health alleging it improperly charged Medicare and another government health care program for physical therapy services has helped the U.S. government recover $1.5 million. The U.S. Justice Department (DOJ) and the whistleblower complaint alleged that Scripps Health submitted false claims to the Medicare and TRICARE programs for physical therapy services provided by therapists who lacked the proper credentials and billing privileges and were not supervised by a physician or other qualified health care provider. According to the DOJ, Medicare and TRICARE – the health care program for active servicemembers and their ... Read More

Alex Azar Nomination Opposed in Letter to Senate

More than 60 health care and consumer organizations have sent a letter to the U.S. Senate urging lawmakers to oppose the confirmation of Alex Azar, the former head of Eli Lily and Company’s U.S. division, to Secretary of Health and Human Services. “The undersigned organizations, representing patients, healthcare providers, public health experts, women, people of color, workers, consumers, and people of faith strongly urge you to vote against confirming Alex Azar … We are deeply concerned by statements made by Mr. Azar as well as his record at the pharmaceutical firm Eli Lilly and Company,” the letter states. The authors ... Read More

Kmart Settles Whistleblower Drug Pricing Suit For $32.3 Million

Kmart Corporation will pay the United States $32.3 million to settle False Claims Act allegations brought by a whistleblower who alleged the retailer failed to report discounted prescription drug prices to government health care programs, resulting in the U.S. paying more for drugs than it should have. The U.S. Department of Justice said that James Garbe, a pharmacist at a Kmart store in Ohio, sued Kmart in 2008 under the whistleblower provisions of the False Claims Act, which allow private parties to sue on behalf of the U.S. government in cases of suspected fraud. The whistleblower lawsuit alleged that Kmart ... Read More

Whistleblower Helps U.S. Recover $26 Million From Florida Oncology Group

A whistleblower proved to be instrumental in exposing illegal practices within 21st Century Oncology Inc. of Fort Myers, Florida, and several of the company’s subsidiaries and affiliates, and the defendant companies have agreed to pay $26 million to resolve accusations of False Claims Act and Stark Law violations, the U.S. Department of Justice announced. According to the Fort Myers News-Press, Matthew Moore, a health care executive who briefly served as the interim vice president of financial planning at 21st Century Oncology, filed a whistleblower lawsuit against 21st Century in February 2016. Mr. Moore’s whistleblower lawsuit triggered a federal probe of 21st Century’s ... Read More

Maryland Woman Pleads Guilty to Medicare, Medicaid Fraud

A Maryland woman pleaded guilty to federal health care fraud charges for a scheme in which she falsely represented herself to be a medical equipment vendor for New York-based Medicare and Medicaid management programs. According to the U.S. Department of Justice, Suzanna Meliksetyan, 28, of Gaithersburg, Maryland, purported to operate multiple durable medical equipment companies so that she could submit bogus claims to Healthfirst, a non-profit, New York-based health maintenance organization that administers Medicare Advantage plans and New York Medicaid Managed Care plans. As part of her guilty plea, Ms. Meliksetyan admitted that she operated a number of scam medical ... Read More

Whistleblower Case Reveals Nursing Home Fraud, Abuse

A whistleblower lawsuit was instrumental in exposing the shoddy quality of care provided to the residents of a Mississippi nursing home and recovering $1.25 million for Medicare and the Mississippi Medicaid program, the U.S. Department of Justice said. Academy Health Center Inc., the owner and landlord of a Lumberton, Mississippi, building housing the Oxford Health and Rehabilitation skilled nursing home, filed the lawsuit under the whistleblower provisions of the False Claims Act against Hyperion Foundation and its former president Julie Mittleider and AltaCare Corporation and its CEO Douglas Mittleider. The lawsuit also named related companies Long Term Care Services Inc. ... Read More