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Medicaid 254 articles

Whistleblowers help U.S. Recover Nearly $54 million

Genesis Healthcare Inc. has agreed to pay the federal government nearly $54 million to settle six whistleblower lawsuits alleging the company and its subsidiaries submitted false claims to Medicare, Medicaid, and TRICARE for unnecessary therapy and hospice services and provided “grossly substandard” care in its nursing homes. The Pennsylvania-based health care system, which owns and operates skilled nursing facilities, assisted/senior living facilities, and a rehabilitation therapy business, will pay the U.S. $53.64 million plus interest to resolve multiple allegations lodged by the whistleblower lawsuits. According to the U.S. Department of Justice, three Genesis subsidiaries in Nevada intentionally billed Medicare for ... Read More

Pathology Practice Pays $601K to Settle Whistleblower Suit

A North Carolina pathology practice has agreed to pay the U.S. $601,000 to settle a whistleblower’s False Claims Act lawsuit alleging it billed Medicare and Medicaid for medically unnecessary procedures. The U.S. Department of Justice said that Piedmont Pathology of Hickory, North Carolina, was performing special tissue stain tests for diagnostic purposes before analyzing the routine hematoxylin and eosin (H&E) stain tests. The government considered the special tests costly and unnecessary because “a pathologist should review the specimen with the routine H&E stain before any special stain is used on the specimen,” the Justice Department said. “Government health care programs ... Read More

Whistleblower Helps Indiana, U.S. Recover $18 Million in Medicaid Funds

A whistleblower lawsuit accusing Indiana University Health Inc. and HealthNet Inc. of engaging in an illegal kickback scheme has ended with an $18 million settlement, federal and state official announced April 27. The lawsuit, originally filed by Dr. Judith Robinson under the whistleblower provisions of the False Claims Act, alleged Indiana University Health provided HealthNet with an interest-free line of credit in part to coax HealthNet to refer its obstetrics and gynecology patients to IU Health’s Methodist Hospital. The whistleblower suit claims this scheme violated the federal Anti-Kickback Statute and the federal and state False Claims Act. The state’s involvement ... Read More

Massachusetts backs whistleblower lawsuit alleging Medicaid fraud

The state of Massachusetts is backing a whistleblower lawsuit against Universal Health Services (UHS), alleging the Pennsylvania-based hospital network submitted false claims to the state’s Medicaid program. The state’s intervention in the case builds on allegations originally brought by the parents of a teenage girl who died in 2009 after having an adverse reaction to medication prescribed to her by an employee of Arbour Counseling Services, a unit of UHS in Lawrence, Massachusetts. The complaint alleges that the Arbour Counseling employee who prescribed the medication to the teen was unqualified to dispense drugs. A subsequent investigation into the complaint found ... Read More

Whistleblower Complaint Leads To $115 Million Jury Verdict Against Florida Nursing Home Facilities

A federal jury in Tampa, Florida, returned a $115 million verdict in a False Claims Act complaint brought by a nurse against a nursing home facility, its parent company, and other defendants. Plaintiff Angela Ruckh filed the False Claims Act suit in 2011, naming Governor’s Creek and Marshall nursing facilities; management company, LaVie Management; LaVie Rehab; and CMC II, the new corporate owner of the facilities, as defendants. Ms. Ruckh’s lawyer told Corporate Crime Reporter that his client started working for the companies to help train the nurses that fill out the forms, which are used to bill Medicare and ... Read More

Whistleblower Complaint Leads to Multiple Arrests In Massive Health care Fraud Scheme

A False Claims Act lawsuit filed by a whistleblower and resulting investigation of those claims has led to the arrest of a New York City-area cardiologist, neurologist, and several others on charges of health care fraud, identity theft, and making false statements, among other things, as well as civil allegations that they defrauded Medicare, Medicaid, and private health insurance companies. Preet Bharara, the U.S. Attorney for the Southern District of New York, and other federal officials announced the charges March 1, saying that the defendants’ wrongdoing spanned 12 years starting in 2003 and cost taxpayers and private insurers more than ... Read More

Whistleblower Lawsuit Claims Ohio Treatment Center Cheated Troubled Teens, U.S. Taxpayers

A whistleblower who filed a False Claims Act lawsuit against one of the country’s largest private prison companies claims an Ohio residential treatment center for teens fraudulently billed Medicaid for counseling sessions that never happened. Whistleblower Lynn Rocroft spoke to WKYC Channel 3 News about rampant fraud she alleges occurred at Abraxas Ohio in Shelby, an all-male treatment center owned and operated by GEO Group Inc. Ms. Roycroft, who has more than three decades of counseling experience, started working for Abraxas in 2008. She told WKYC that fraud at the center “was totally out of control when I got there.” ... Read More

U.S. Joins Whistleblower lawsuit Against UnitedHealthcare

The U.S. government has joined a former UnitedHealth executive in a whistleblower lawsuit alleging the company “engaged in systematic fraud” that allowed it, subsidiary companies, and other insurers to fraudulently overcharge Medicare by “hundreds of millions — and likely billions — of dollars.” Benjamin Poehling, the former finance director for UnitedHealthcare Medicare and Retirement, a subsidiary that works with the Medicare Advantage program, filed the lawsuit in federal court in Los Angeles in 2011 under the whistleblower provisions of the False Claims Act. The lawsuit remained under seal for years while federal officials investigated Mr. Poehling’s claims. It became public ... Read More

Oklahoma Joins Federal Government in whistleblower Lawsuit Alleging Kickbacks, False Claims

The state of Oklahoma has joined federal prosecutors in alleging that the Oklahoma-based Emergency Medical Services Authority (EMSA) and its director Stephen Williamson accepted millions of dollars in illegal kickbacks from a company that formerly provided Oklahoma’s ambulance services. The Oklahoma Attorney General’s Office filed a complaint in a Texas federal court seeking to partially intervene in a whistleblower lawsuit against EMSA, a public trust that provides ambulance service to more than 1.1 million people in the Oklahoma City and Tulsa areas. The state alleges that EMSA and Mr. Williamson engaged in a kickback scheme regarding highly profitable ambulance services ... Read More

Hospital Staffing Firm Agrees To Pay U.S. $60 Million To Settle False Claims Act Lawsuit

TeamHealth Holdings, a major U.S. hospital service provider, has agreed to pay $60 million plus interest to settle a False Claims Act lawsuit filed by a physician who accused IPC Healthcare Inc., a hospital manager that TeamHealth acquired, of overcharging federally funded health care programs for the services it performed. Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist, filed the original lawsuit under the whistleblower provisions of the False Claims Act, which allows private parties to sue on behalf of the federal government in cases of suspected fraud. Federal prosecutors investigated Dr. Oughatiyan’s claims and chose ... Read More