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Medicare 312 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 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

Whistleblower Awarded $17 Million for Exposing Medicare Fraud

A whistleblower who filed a False Claims Act lawsuit against Prime Healthcare Services, one of the nation’s largest hospital chains, and its founder and chief executive officer, has received an award of $17,225,000 for helping the U.S. recover $65 million in Medicare funds. The U.S. Department of Justice said that Karin Berntsen, the former Director of Performance Improvement at Alvarado Hospital Medical Center in San Diego, brought the suit under the whistleblower provisions of the False Claims Act. Ms. Berntsen alleged that Prime Healthcare Services, Prime Healthcare Foundation, Prime Healthcare Management, and CEO Dr. Prem Reddy routinely admitted Medicare patients ... Read More

Whistleblower Key in Recovering $8.5 Million from Tennessee Hospice Provider

A Tennessee hospice provider will pay the U.S. $8.5 million plus interest to settle a whistleblower lawsuit brought by a former nurse who claimed the company defrauding Medicare and Medicaid with false claims. The settlement resolves allegations lodged against Caris Healthcare L.P. by whistleblower Barbara Hinkle, a registered nurse who formerly worked for the hospice provider.  Ms. Hinkle sued Caris on behalf of the U.S. government under the whistleblower provisions of the False Claims Act. According to the U.S. Attorney’s Office for the Eastern District of Tennessee, which helped prosecute the case, Caris sought and admitted patients into its hospice ... 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

Whistleblower Case Leads To $114 Million Judgement Against Ex-Diagnostic Lab CEO, Others

Three whistleblower lawsuits played a key role in a $114 million judgment against Health Diagnostics Laboratory CEO LaTonya Mallory and two other individuals who allegedly co-conspired to pay physicians kickbacks for patient referrals and causing the submission of false claims to Medicare for diagnostic tests that patients didn’t need. According to the U.S. Department of Justice, the government intervened in the whistleblower lawsuits and consolidated them in federal court in Charleston, South Carolina. During a two-week jury trial, federal prosecutors presented evidence that Ms. Mallory and co-defendants Floyd Calhoun Dent III and Robert Bradford Johnson paid kickbacks to doctors disguised ... Read More

Whistleblower Key in Recovering $1.2 Million From Florida Pain Clinic

A doctor who filed a whistleblower lawsuit against a Jacksonville, Florida-based pain management clinic was instrumental in helping the U.S. government recover more than $1.2 million for Medicare, TRICARE, and other federally subsidized health care programs. U.S. Attorney Maria Chapa Lopez of the Middle District of Florida said Riverside Spine & Pain Physicians agreed to pay the U.S. $1,204,415 to settle a complaint filed by Dr. Carissa Stone, a former employee of the clinic. Dr. Stone filed the lawsuit under the whistleblower provisions of the False Claims Act, alleging the clinic billed Medicare and other U.S. health care programs for ... 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

Georgia Whistleblower Exposes $3.2 Million Kickback Scheme

A whistleblower who sued a group of Atlanta-area orthopedic and anesthesia providers for their alleged participation in an illegal kickback scheme has helped the U.S. government recover $3.2 million for Medicare. According to the U.S. Department of Justice (DOJ), the whistleblower lawsuit led to a settlement agreement between the federal government and Georgia Bone & Joint; Summit Orthopaedic Surgery Center; Southern Crescent Anesthesiology; and Sentry Anesthesia Management, as well as nurse anesthetist David LaGuardia. The whistleblower complaint, brought by Sharon Kopko, former Practice Administrator for Georgia Bone & Joint, alleged that Mr. LaGuardia, Sentry, and Southern Crescent provided a free ... Read More