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Medicaid 254 articles

Walgreens Settles Two Whistleblower Lawsuits for $269.2 Million

Walgreens Boots Alliance, the holding company that owns the controlling shares of Walgreens Drug Stores and several other health care companies, will pay $269.2 million to settle two separate whistleblower lawsuits. In one case, Walgreens agreed to pay $209.2 million to settle allegations that it fraudulently billed Medicare, Medicaid, and other government health care programs for hundreds of thousands of insulin pens that beneficiaries did not need. According to the U.S. Attorney’s Office for the Southern District of New York, Walgreens configured its electronic systems so that its pharmacists couldn’t dispense less than a full box of five insulin pens, ... Read More

Whistleblower Suit Against Abbott, AbbVie Recovers $25 Million For U.S. Taxpayers

Abbott Laboratories and AbbVie Inc. have agreed to pay more than $25 million to settle a long-standing whistleblower lawsuit claiming the drug companies illegally promoted the triglyceride drug TriCor for off-label purposes and provided doctors and other prescribers with unlawful kickbacks to boost sales. Amy Bergman, a former Abbott sales representative, filed the lawsuit under the whistleblower provisions of the False Claims Act in 2009. The U.S. Department of Justice declined to intervene in the case, but it moved ahead without the government’s direct involvement, surviving attempts by Abbott and AbbVie to have the case thrown out. According to the ... Read More

Whistleblower Helps Medicare Recover $4 Million From Florida Dermatology Practice

A dermatologist who filed a whistleblower lawsuit against a Florida dermatology practice alleging it defrauded Medicare and Medicaid has helped the U.S. government recover $4 million. Dermatology Healthcare, a Tampa-based provider of dermatology care to residents of assisted living facilities, agreed to settle the government’s claims of fraud, which originated with a False Claims Act lawsuit filed by Dr. Theodore A. Schiff, according to an announcement by U.S. Attorney Maria Chapa Lopez. Dr. Schiff filed the lawsuit under the whistleblower provisions of the False Claims Act, alleging Dermatology Healthcare failed to adequately supervise the administration of superficial radiation therapy to ... Read More

Whistleblowers’ Nursing Home Fraud Suit Leads to $30 Million Settlement

Two whistleblowers who filed False Claims Act allegations against a large Kentucky-based nursing home corporation have helped the U.S. government and the state of Tennessee recover more than $30 million for Medicare. The whistleblowers, both former employees of Signature Healthcare LLC, accused the company of defrauding Medicare by providing rehabilitation therapy services that were not reasonable, skilled, or needed by patients. Signature owns about 115 skilled nursing facilities, including seven in Tennessee’s middle district, where the whistleblowers filed their complaint in federal court. One of the whistleblowers, Kristi Emerson, told The Tennessean she worked at Signature Healthcare of Columbia for more ... Read More

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

Walmart Pays $825,000 to Settle Whistleblower’s Medicaid Allegations

Walmart Stores and Sam’s Club have agreed to pay the U.S. and Minnesota $825,000 to resolve allegations that they violated the federal and state False Claims Acts for violating Medicaid rules for automatic prescription refills. U.S. Attorney Gregory Brooker and Minnesota Attorney General Lori Swanson jointly announced the settlement, which they said stemmed from a lawsuit filed by a whistleblower under the False Claims Act. Minnesota is one of about 20 states that does not allow Medicaid beneficiaries to have their prescription drugs automatically refilled. Instead, the state’s Medicaid program, called Medical Assistance, requires beneficiaries to request refills. The state’s ... Read More

The Arc of Anchorage Settles False Claims Act Allegations

The Arc of Anchorage, an organization supporting Alaskans with intellectual and developmental disabilities, has agreed to pay nearly $2.3 million to settle a False Claims Act complaint alleging it defrauded Alaska’s Medicaid Program. In an April 24 announcement, the Alaska Department of Law said the State of Alaska accused Arc of Anchorage of billing Medicaid for services that it never provided and billing for overlapping services with the same provider. Additionally, the state further alleged that Arc of Anchorage failed to repay funds owed to the Medicaid program that the organization had identified in fiscal audits. The allegations constitute violations ... Read More

Oklahoma Ambulance Provider Settles Whistleblower Kickback Allegations

An Oklahoma ambulance service provider will pay $300,000 to settle a whistleblower lawsuit alleging it violated the federal False Claims Act and Anti-Kickback Statute by engaging in an unlawful kickback scheme with a former Texas contractor. According to Tulsa World, a whistleblower lawsuit provided the basis for allegations lodged by federal officials. The complaint alleged that Emergency Medical Services Authority (EMSA), its former president and CEO Stephen Williamson, and contractor Paramedics Plus LLC controlled a slush fund that they used to pay out more than $20 million in kickbacks, including $50,000 or more for Mr. Williamson’s personal benefit. The State ... Read More

Whistleblower Case Recovers $1.65 Million From Vermont Hospital

A whistleblower complaint filed against a Vermont hospital by one of its former administrators has ended in a $1.65 million settlement. Brattleboro Memorial Hospital agreed to pay the U.S. and the State of Vermont the sum to resolve allegations that it knowingly submitted or caused the submission of false claims to the Medicare and Medicaid programs. Amy Beth Main filed the lawsuit on behalf of the U.S. and Vermont under the whistleblower provisions of the federal and Vermont False Claims Acts. Plaintiff’s counsel told the Brattleboro Reformer that Ms. Main, an administrator in Brattleboro Memorial’s financial services department, “protested internally” ... Read More

Court Reinstates LHC Home Health Nurse’s Whistleblower Case

A nurse who filed a whistleblower retaliation lawsuit against her employer even though she wasn’t demoted, harassed or terminated, can move forward with her case, a federal appeals court ruled. Sue Smith, a former nursing director for Louisiana-based home health care agency LHC Group Inc., filed the whistleblower retaliation lawsuit after she allegedly became aware of a scheme to defraud Medicare and Medicaid. Ms. Smith worked at LHC’s home health office in Lexington, Kentucky. According to Business Insurance, Ms. Smith claims employees of the home health office routinely sidestepped federal rules and admitted patients into care without the clinical evaluation ... Read More