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Medicaid 254 articles

Whistleblower Complaint Ends With $6.5 Million Settlement

Vanderbilt University Medical Center has paid more than $6.5 million to resolve a whistleblower lawsuit alleging the hospital engaged in wrongful billing practices that resulted in it receiving higher reimbursements from Medicare and Medicaid. The settlement brings to an end a protracted dispute initiated by anesthesiologists formerly employed by VUMC. The physicians filed the lawsuit on behalf of the U.S. government and the state of Tennessee in 2011 under the whistleblower provisions of the False Claims Act. The federal government and Tennessee government declined to intervene in the case, but the whistleblowers pressed ahead with their allegations. According to the ... Read More

Celgene Pays $280 Million To Settle Whistleblower Lawsuit

Celgene Corp. has agreed to pay the U.S. $280 million to settle a whistleblower lawsuit alleging the pharmaceutical company defrauded Medicare and several state health care programs by promoting two drugs for purposes unapproved by federal regulators. According to the office of Sandra Brown, Acting U.S. Attorney for the Central District of California, the New Jersey-based drug company promoted the cancer treatment drugs Thalomid and Revlimid for off-label uses that the U.S Food and Drug Administration (FDA) never approved and which were not covered by federal health care programs. But it was Celgene’s promotion of Thalomid, a drug originally prescribed ... Read More

Whistleblower Lawsuit Recovers $42M From LA Hospital

A Los Angeles hospital and its owners agreed to pay $42 million to settle a whistleblower’s False Claims Act lawsuit alleging they engaged in illegal kickback schemes and other improper financial arrangements that violated the Anti-Kickback Statute, the Stark Law, and the False Claims Act. After investigating whistleblower Paul Chan’s claims about allegedly unlawful practices at Pacific Alliance Medical Center, the U.S. Department of Justice opted to back the lawsuit. Mr. Chan filed the suit in 2013 after having been employed by the acute-care hospital in a management position for about 10 weeks. It wasn’t long after starting work at ... Read More

Tennessee Pain Chain Settles False Claims Act Allegations

A group of Tennessee pain clinics has agreed to pay $312,000 to settle federal and state False Claims Act allegations that it caused the submission of false claims for medically unnecessary urine tests and other misconduct that defrauded Medicare and Medicaid. According to the U.S. Attorney’s Office for the Middle District of Tennessee, Antioch-based Pain Management Group P.C.’s activity caused Medicare and TennCare, Tennessee’s Medicaid program, to pay for urine drug tests that were not medically necessary. The company operates seven pain-management centers in the Nashville area. Pain Management Group also caused the submission of false claims to the same ... Read More

Doctor Faces False Claims Act charges of Medicaid Fraud

Connecticut initiated a False Claims Act lawsuit against a Norwalk doctor and his practice, alleging they defrauded the state’s Medicaid program out of thousands of dollars by billing it for services that were never performed. “The audacity of the alleged fraudulent conduct in this case is astounding,” said Attorney General George Jepsen. “In one case, this provider billed Medicaid for at least 500 visits to a particular patient that never happened, receiving $80,000 in taxpayer dollars for services never rendered, and at the same time, sought to receive Medicaid benefits himself. “ The state’s False Claims Act lawsuit alleges that ... Read More

Whistleblower Case against Gilead Sciences Revived

A whistleblower lawsuit against drugmaker Gilead Sciences Inc. alleging the company misled federal drug regulators into approving adulterated HIV drugs has been revived by a federal appeals court. The Recorder reports that the Ninth Circuit Court of Appeals ruling reverses a California Court’s dismissal of the case. The appellate court said in its opinion that the claims made by whistleblowers Jeff and Sherilyn Campie, both former Gilead employees, are sufficient and satisfy the requirements of a False Claims Act complaint. The Campies accuse Gilead of using synthetics from a manufacturer in China to lower the production costs of its HIV ... Read More

‘Largest-Ever’ Health care Fraud Sweep Results in 400-Plus Arrests

A massive federal crackdown on health care fraud has resulted in charges against more than 400 people nationwide, and prosecutors allege their false billings to the government have cost taxpayers about $1.3 billion. U.S. officials said Thursday the takedown was the “largest ever health care fraud enforcement action” by the Medicare Strike Force. It involved more than a thousand law enforcement agents arresting 412 individuals in 30 states. About a quarter of those currently facing health care fraud charges from the action are doctors, nurses, and other medical professionals. While the health care fraud sweep could return some funds to ... Read More

J&J Dropped From Whistleblower Suit

Johnson & Johnson is being dropped from a whistleblower lawsuit accusing it of promoting its HIV/AIDS drugs for off-label purposes and other wrongdoing, but most of the same claims against subsidiary company Janssen can move ahead, a federal judge ruled. According to the New Jersey Law Journal, New Jersey federal Judge Michael Shipp granted and denied parts of J&J’s motion to dismiss the whistleblower case by releasing the drug giant from the suit but allowing allegations against its Belgium-based Janssen subsidiary to stand. Judge Shipp said that J&J was off the hook because “mere ownership of a subsidiary does not ... Read More

Allergan Pays $13M To Settle Whistleblower Suit

A whistleblower lawsuit filed by two Philadelphia ophthalmologists against multinational drug corporation Allergan has been settled in court, with the defendant agreeing to pay more than $13 million. The settlement resolves allegations that Allergan, which is headquartered in Dublin, Ireland, and Parsippany, New Jersey, illegally promoted its Restasis eye drug and other eye drugs for off-label purposes and provided kickbacks to physicians for writing more prescriptions for the drugs. According to The Philadelphia Inquirer, the lawsuit was brought by Herbert J. Nevyas and Anita Nevyas-Wallace, a father and daughter team of ophthalmologists. The pair filed the suit under the whistleblower ... Read More

Whistleblower Lawsuit draws $6.5 Million Settlement

A whistleblower’s False Claims Act lawsuit against Carolinas Healthcare System has resulted in a $6.5 million recovery for the federal and North Carolina Medicaid programs. According to U.S. Attorney Jill Westmoreland Rose of the Western District of North Carolina, the Charlotte-based hospital system improperly up-coded claims it submitted for urine drug tests so it would receive higher Medicaid reimbursements. Federal prosecutors contended that from 2011 to 2015, Carolinas HealthCare conducted urine drug tests, categorized as “moderate complexity” tests by the Food and Drug Administration (FDA), but submitted claims for “high complexity” tests. Claims submitted to federal health care programs include ... Read More