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whistleblower 940 articles

Whistleblowers Help Recover $10 Million From Alabama, Florida Nursing homes

Two management consulting companies and nine affiliated Alabama and Florida nursing homes will pay $10 million to settle a False Claims Act lawsuit filed by a whistleblower who accused the defendants of scheming to provide patients with unnecessary therapy and then billing Medicare for the unneeded services. According to the U.S. Department of Justice, Southern SNF Management, Inc., Rehab Services in Motion (doing business as Dynamic Rehab) and the nursing homes instituted corporate policies and practices that encouraged the nursing facilities to provide patients with “medically unreasonable and unnecessary therapy without regard for patients’ individual clinical needs.” The defendants then ... Read More

Former Bulletproof Vest Maker Settles Whistleblower Lawsuit

The founder and former president of a bulletproof vest manufacturing company will pay the U.S. more than $1.3 million to settle allegations of fraud stemming from a whistleblower lawsuit. The U.S. Department of Justice said that to resolve the lawsuit, Robert David, the former head of now-defunct Second Chance Body Armor, will relinquish $1.2 million in assets previously frozen by the U.S. government and pay an additional $125,000 — an amount based on his ability to pay. Second Chance made many of its bulletproof vests with Zylon fiber produced by Toyobo Co. of Japan, then sold the bulletproof vests to ... Read More

Whistleblower Dentists Describe Harrowing Kool Smiles Practices

Whistleblowers who risked their careers, reputations, and potentially even their personal safety are calling out Kool Smiles, a national pediatric dental chain, for businesses practices that allegedly put children through painful and unnecessary procedures, just so they could increase their billings. Dentists Dr. Rai and Dr. Greenwald recounted their experiences at Kool Smiles to CBS News as part of a new series the network is airing about whistleblowers who risk everything to expose wrongdoing. In the Whistleblower series’ first segment, Dr. Rai told CBS News that she “lived in fear every day” about what she would face at Kool Smiles. ... Read More

Whistleblower Case Leads to $1.7M Recovery From Florida Urogynecology Group

A Florida network of urogynecologists has agreed to pay $1.7 million to settle a whistleblower’s False Claims Act lawsuit alleging the company billed Medicare for patient services that were never provided. The settlement resolves a whistleblower lawsuit filed by Holly Loebl, a former employee of FWC Urogynecology LLC, who accused the same company of knowingly misusing a certain Medicare billing code called “modifier 25,” which adds fees for extra services to Medicare billings, the U.S. Attorney in Orlando said. Orlando-based FWC Urogynecology operates more than a dozen clinics throughout Florida. Ms. Loebi filed her lawsuit under the whistleblower provisions of ... Read More

Whistleblower Sues Montana Hospital over Alleged Kickback Scheme

A newly unsealed whistleblower complaint against Kalispell Regional Healthcare accuses the Montana hospital of engaging in an extensive kickback scheme that put the profits of specialist physicians and hospital executives above patient care while defrauding U.S. and Montana taxpayers. The newly unsealed suit was originally filed in September 2016 by John Mohatt, formerly the CEO of Kalispell Regional Healthcare’s physician network. An amended False Claims Act complaint was filed in May of last year and remained under seal until recently, although the U.S. Department of Justice continues to investigate the whistleblower’s allegations, Kalispell’s Flathead Beacon reports. U.S. law prohibits hospitals ... Read More

Whistleblower’s Suit Against Roche, Humana Survives Motions to Dismiss

A whistleblower’s $45 million False Claims Act lawsuit alleging Humana and Roche Diagnostics engaged in an illegal kickback scheme and other health care fraud will stand after an Illinois federal judge rejected two motions to dismiss the allegations. Crystal Derrick, a former Roche account manager, filed the whistleblower complaint on behalf of the U.S. government in 2014, HealthPayer Intelligence reports. She alleges that Roche improperly dismissed debt Humana owed to Roche in a bid to keep Roche Diagnostic’s diabetes testing products on Humana’s formularies. The deal also helped bar competitor products from Humana’s formularies, the whistleblower complaint alleged. According to Louisville Business ... Read More

Health Quest Pays $14.7 million To Resolve Whistleblower Allegations

Health Quest Systems Inc. and one of its hospitals will pay $14.7 million to settle three whistleblower complaints filed under the False Claims Act alleging the New York-based hospital system and one of its hospitals submitted inflated and ineligible claims to Medicare for reimbursement. In the settlement announced by the U.S. Department of Justice, Health Quest and Putnam Health Center of Carmel Hamlet, New York “admitted, acknowledged, and accepted responsibility for certain facts involving the submission of improper claims for various health-related services,” the Justice Department said. The whistleblowers alleged that Health Quest submitted for evaluation and management services but ... 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