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Medicaid 254 articles

Whistleblower Allegations Lead To Prison Sentence, Fines For Medical Equipment Vendor

The owner of an Iowa medical supply store has been sentenced to more than three years in prison for submitting falsified documents to federal authorities investigating fraud allegations raised by a whistleblower in a False Claims Act lawsuit. According to The (Cedar Rapids) Gazette, James O’Connor, 64, was sentenced to 37 months in federal prison and ordered to pay $350,000 in restitution to the Medicare and Medicaid programs. Mr. O’Connor owned and operated O’Connor Medical Supply Inc., a durable medical equipment vendor in the Des Moines, Iowa area. A whistleblower filed a False Claims Act suit against Mr. O’Connor and ... Read More

Whistleblower Sues Epic Systems, Alleging Fraudulent Double Billing

A whistleblower suing Verona, Wisconsin-based Epic Systems alleges the medical IT company’s software defaults to double-billing Medicare and Medicaid for anesthesia services, costing U.S. taxpayers to overpay by hundreds of millions of dollars. According to Law 360, Geraldine Petrowski, an employee of Raleigh, North Carolina-based WakeMed Health between 2008 and 2014, filed the False Claims complaint against Epic under the whistleblower provisions of the False Claims Act after her experiences with implementing Epic’s billing system raised “major concerns” about overbilling the government. Ms. Petrowski’s whistleblower complaint contends that Epic’s billing software defaults to charging Medicare and Medicaid for actual time ... Read More

Whistleblower Law Repeal Makes Wisconsin Fraud-Friendly State

Wisconsin’s whistleblower law protecting taxpayer-funded state agencies and programs from fraud was quietly repealed by Governor Scott Walker in the 2015-17 state budget – a move that is costing the state’s taxpayers millions of dollars. According to the Wisconsin State Journal, Gov. Walker’s repeal of the state’s False Claims Act has already cost Wisconsin taxpayers an estimated $11 million in settlement money from companies that have defrauded the Medicaid program. That’s $11 million out of taxpayers’ pockets and into the bank accounts of corporate cheats. The $11 million estimate “was produced by the Wisconsin Center for Investigative Journalism using methodology ... Read More

Medicaid Fraud targeted by Massachusetts to Fight Opioid Addiction

The State of Massachusetts is tackling Medicaid fraud and opioid addiction by warning doctors who provide treatment services through the state’s Medicaid program not to unlawfully charge patients struggling with addiction to opioid painkillers. Massachusetts law requires providers of opioid addiction treatment to accept payment from the state’s Medicaid program, MassHealth, as full payment for their services. The buprenorphine-based drugs Suboxone, Subutex, and Vivitrol are used to treat opioid addiction under the Medicaid program to suppress opioid withdrawal and cravings. According to Massachusetts Attorney General Maura Healey, the state has brought numerous criminal and civil enforcement actions against Medicaid providers that ... Read More

New Jersey Adult Daycare Settles Medicaid Fraud Allegations

An Edison, New Jersey adult daycare facility and its former and current owners have agreed to pay the U.S. and State of New Jersey nearly $3 million to settle allegations that they improperly billed and received payments from the Medicaid program. The U.S. Attorney’s Office for the District of New Jersey sued Edison Adult Medical Daycare, its former owner Dinesh Patel, and current owners Daxa Patel and Satish Mehtani for violations of the False Claims Act, alleging the company billed Medicaid and received reimbursements from the health care program even though Mr. Patel had been excluded from participating in Medicaid ... Read More

Aegerion Pays U.S. $40 Million to Settle Drug Fraud Charges

Aegerion Pharmaceuticals agreed to plead guilty to criminal charges involving its marketing and sales of a costly cholesterol drug and pay the U.S. government more than $40 million, ending two federal probes into its businesses practices. The U.S. Department of Justice (DOJ) said the Cambridge, Massachusetts-based drug company will pay $36 million to resolve an investigation of its alleged submissions of false claims to Taxpayer-funded health care programs such as Medicare, Medicaid, and TRICARE for the drug Juxtapid. According to the DOJ, the U.S. Food and Drug Administration (FDA) approved Juxtapid in 2002 for treating a rare genetic condition that ... Read More

Novo Nordisk Settles Whistleblower Complaints Alleging Victoza Fraud

Novo Nordisk has agreed to pay nearly $59 million to settle seven whistleblower lawsuits accusing the Danish multinational drug company of violating the Federal Food, Drug, and Cosmetic Act (FDCA) and False Claims Act (FCA) by downplaying the health risks of its diabetes drug Victoza. The U.S. Justice Department said Tuesday’s settlement settles allegations that Novo Nordisk fed information to doctors through its sales force that created false or misleading impressions that the U.S. Food and Drug Administration (FDA)-mandated warnings for Victoza were wrong or unimportant. After the FDA approved Victoza as a Type II diabetes treatment in 2010, it required ... Read More

Whistleblower Suit Leads To $12 Million Recovery From New Mexico Hospital

A whistleblower lawsuit against a Santa Fe, New Mexico hospital and its Texas-based parent company has led to a recovery of more than $12 million in federal and state Medicaid funds. Christus St. Vincent Regional Medical Center, part of the Christus Health network of hospitals, reached a settlement last week with the U.S. Justice Department, which had supported a False Claims Act lawsuit filed in 2011 by Diana Stepan, a former public health official for Los Alamos County. Ms. Stepan, who died last year, claimed that Christus St. Vincent engaged in a scheme involving New Mexico’s Sole Community Provider program, ... Read More

Whistleblower Recovers $2 Million For California Medicaid Recipients

Two Bay Area companies and the two individuals who head them will pay $2 million to resolve whistleblower allegations that they violated the federal and state False Claims Act by knowingly overbilling a program designed to serve Californians with developmental disabilities. Whistleblower Beverly McCaffery originally filed the False Claims Act lawsuit, accusing Alternative Learning Center, its president Alice Soard, and Adult Educational Technologies Inc., and its executive director Wendell James, of defrauding California’s Department of Developmental Services (DDS) by billing for services that were never provided, U.S Attorney for the Eastern District of California Phillip Talbert announced. The whistleblower lawsuit ... Read More

Georgia Hospital Settles Medicare Fraud Whistleblower Lawsuit

A whistleblower lawsuit filed against Navicent Health by a paramedic who claimed the Macon, Georgia, hospital deliberately overbilled Medicare and Medicaid for ambulance trips has been settled for $2.5 million. According to The (Macon) Telegraph, U.S. Attorney Pete Peterman announced a resolution of the whistleblower lawsuit, brought by former Navicent paramedic Andre Valentine in 2015. Mr. Valentine’s allegations that Navicent was overbilling the government for ambulance trips, many of which were medically unnecessary, triggered a 27-month investigation by the federal government, which chose to back the allegations. The False Claims Act lawsuit alleged that Navicent cheated the government health care ... Read More