Renown Health has agreed to pay $9.5 million to settle allegations that it submitted false claims to Medicare for in-patient hospital services. According to a whistleblower complaint, the services should have been billed at much lower rates for out-patient or observation services.
The settlement resolves a qui tam or whistleblower lawsuit brought by a former employee under the False Claims Act. That law allows individuals with evidence of false claims to commence a lawsuit on behalf of the government and share in any recovery. The whistleblower in this case will receive a $1.7 million reward from the settlement. During her employment as Director of Clinical Compliance, the whistleblower noticed a number of technical billing discrepancies. One of the issues she noticed was the submission of claims to Medicare for in-patient care when it appeared that the patients had never been admitted to the hospital. After bringing her concerns to management without any success, the whistleblower brought her concerns to the government in the form of a qui tam lawsuit. Qui tam lawsuits are filed “under seal” (that is, in secret) to allow the government time to investigate before the defendant learns that it is a suspect in a Medicare fraud investigation. The government then decides whether to pursue the lawsuit on its own, or to allow the whistleblower, known as a “relator,” to pursue the lawsuit on its behalf. If the government pursues the lawsuit and wins, the relator is entitled to a reward of between 15% and 25% of the amount actually recovered. If the relator pursues the lawsuit on behalf of the government, then she is entitled to a reward of between 25% and 30% of the amount recovered plus her attorney’s fees and costs. If you have evidence of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to legal protections and a significant financial reward. There are, however, strict procedural requirements and time limits to qualify for a whistleblower reward. You should not delay. To schedule a free and confidential consultation with a whistleblower lawyer, call John Howley, Esq. at (212) 601-2728.
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The government has arrested more than 300 physicians, clinic owners, and other healthcare professionals for stealing more than $900 million from Medicare.
The defendants are charged with a number of different Medicare fraud schemes including home healthcare fraud and pharmacy fraud. In most cases, the government charges that the defendants billed for services that were not medically necessary or were never actually provided to patients. Some of the defendants are accused of recruiting drug addicts on the streets and in homeless shelters by offering them narcotics in return for their Medicare or Medicaid cards. The defendants allegedly used the Medicare and Medicaid cards to bill for services that were not medically necessary and, in many case, not actually provided. In one case, an individual pharmacist in New York is accused of obtaining more than $51 million by filing fraudulent Medicare and Medicaid claims. Today’s nationwide takedown exceeds a record set last year, when 243 defendants were arrested for defrauding Medicare of more than $700 million. Think about that for a moment. Every year, the government arrests people who steal billions of dollars from the Medicare and Medicaid program. Every year! Medicare and Medicaid fraud is a threat to every hard-working citizen in this country. When billions of dollars are stolen from these programs every year, it puts your future benefits at risk. In fact, the trust fund supporting Medicare is projected to run out of money within the next 10-15 years. If you have evidence of Medicare or Medicaid fraud, you must come forward to help the government put a stop to it. Your efforts will be protected and rewarded. Whistleblowers are entitled to legal protections and financial rewards of up to 30% of the amount recovered by the government. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Medicare and Medicaid have paid out millions of dollars to whistleblowers who have helped uncover violations of the Stark Law, which is also known as the physician self-referral statute.
The Stark law prohibits physicians from referring Medicare or Medicaid patients to other healthcare providers or entities with which the physician or an immediate family member has a financial relationship. A financial relationship includes an ownership interest, a passive investment interest, and compensation arrangements. For example, the Stark Law prohibits a physician from referring patients to an imaging center the physician has invested in, unless an exception applies. The prohibition applies to a long list of "designated health services," including:
The Stark law is a strict liability statute. This means that the government does not have to prove that the physician intended to violate the statute. If the referral violated the Stark Law, then any claims submitted to Medicare or Medicaid are automatically considered “false claims.” The penalties for Stark Law violations are severe. The physician and the entity that received the referrals may be required to pay back up to three times the amount Medicare or Medicaid paid for the services, plus fines of up to $11,000 for each claim. In addition, those involved may be excluded from Medicare and Medicaid programs, and they may face suspension or loss of their professional licenses. Stark Law violations are often difficult for the government to discover. That is why the government relies on whistleblowers to come forward with evidence. In return, the government pays whistleblower rewards of between 15% and 30% of the amount the government recovers. The rewards often amounts to hundreds of thousands of dollars, and sometimes millions of dollars. If you have evidence that a physician or physician practice group is engaged in self-referrals that violate the Stark Law, then you should consult with a whistleblower attorney immediately. You must comply with strict time limits and procedural requirements in order to qualify for a whistleblower reward. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. William LaCorte, a physician in Louisiana, has earned a $59 million whistleblower reward after Pfizer agreed to pay $784 million to settle allegations of false claims to Medicaid for Protonix, a heartburn medication. The complaint alleged that Pifzer’s subsidiary, Wyeth, failed to pay rebates to Medicaid to account for price discounts that Wyeth had provided to other customers.
Dr. LaCorte is no stranger to high-stakes whistleblower litigation. He received $38 million in whistleblower rewards from prior qui tam or whistleblower lawsuits against other pharmaceutical companies, including one in which Merck agreed to pay $250 million to settle allegations that it offered hospitals better terms than Medicaid for its heartburn medicine, Pepcid. Because of whistleblowers like Dr. LaCorte, the government recovered $2.8 billion in settlements last year under the False Claims Act, which allows individuals to commence whistleblower lawsuits on behalf of the government and share in any recovery. In return, the government paid whistleblower rewards totaling $597 million. Pharmaceutical cases tend to result in the largest whistleblower rewards. For example, a former sale representative for Endo Pharmaceuticals recently collected a $33.6 million whistleblower reward after the company agreed to pay $140 million to settle allegations that it engaged in off-label marketing of Lidoderm, a pain medication. In 2012, the government distributed $300 million in whistleblower rewards when GlaxoSmithKline agreed to pay $2 billion to settle allegations of off-label marketing and illegal kickbacks involving a number of its drugs. The key to a successful whistleblower case is having evidence of fraud or false claims submitted to Medicare or Medicaid. Mere allegations or suspicions of fraud are not enough. A successful whistleblower case requires evidence. And that creates some risks for potential whistleblowers. Gathering the evidence to support Medicare or Medicaid fraud claims may expose whistleblowers to allegations that they violated HIPAA privacy restrictions, company confidentiality policies, and even criminal statutes such as the Federal Computer Fraud and Abuse Act. If you have evidence of healthcare fraud or false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and legal protections as a whistleblower. But you also need legal advice to comply with your own obligation to maintain the privacy of confidential information. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Two compounding pharmacies and four physicians have agreed to pay $10 million to settle allegations of false claims submitted to TRICARE, the military’s healthcare program.
The government alleged that one of the compounding pharmacies, Topical Specialists, was created by the four physicians and a pharmacist. The physicians referred their military patients to Tropical Specialists, but it was unable to obtain contracts with government healthcare programs. Topical Specialists then sent its prescriptions to another pharmacy, WELLHealth, which submitted the prescriptions to the federal government. The government alleged that the physicians steered military patients to Tropical Specialists with hundreds of costly prescriptions for pain and scar creams that may not have been medically necessary. Many of the patients told the government that they never used the creams. While the pharmacies billed the federal government tens of thousands of dollars for the creams, the actual cost of compounding the creams was only 4-5% of the amount billed to TRICARE. The government alleged that profits of up to 90% were passed on to the four doctors behind Tropical Specialists. The government also alleged that the four doctors recruited other doctors to write prescriptions to be filled by Tropical or WELLHealth, and passed along 40% of the reimbursement to those doctors. The doctors and the pharmacies settled the government’s fraud claims by agreeing to pay $10 million. False claims to government healthcare programs are very difficult to detect. For this reason, the government offers substantial rewards to whistleblowers who come forward with evidence of false claims to Medicare, Medicaid, and TRICARE. The whistleblower rewards range from 15% to 30% of the amount to government actually recovers plus attorneys’ fees and costs. Anyone who has evidence of false claims can become a whistleblower. This includes physicians, medical and billing staff, patients, vendors and competitors. If you have evidence of false claims submitted to Medicare, Medicaid or TRICARE, then you should consult with an experienced whistleblower attorney immediately to protect your rights. You may be entitled to a significant reward and legal protections. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Whistleblower cases are taken on a contingency fee basis, which means there are no legal fees unless you win. A former billing manager for Pharmasan Labs, Inc. will receive more than $1 million as a whistleblower reward for reporting false Medicare claims for lab tests.
The former billing manager initially raised concerns about false billing with the company’s management. When they did not respond, he filed a whistleblower lawsuit under the qui tam provisions of the False Claims Act. The False Claims Act allows individuals to start a lawsuit “under seal” (i.e., in secret) on behalf of the government for false claims submitted to Medicare and Medicaid. The government is required to conduct an investigation before deciding whether or not to pursue the lawsuit. If the government recovers money as a result of the lawsuit, then the whistleblower is entitled to a reward of between 15% and 30% of the amount recovered. In this case, the government investigated the whistleblower’s claims that Pharmasan submitted false information for laboratory services billed to Medicare and improperly sought reimbursement for services referred by non-physician practitioners. Pharmasan agreed to settle the lawsuit for $8.5 million. The settlement resolves claims that it falsely billed Medicare for ineligible food sensitivity testing and submitted false information to Medicare concerning the nature of the tests. The settlement also resolves claims that its patient referrals for laboratory services came from non-physician practitioners who were not eligible to refer Medicare paid services. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be eligible for a substantial financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. Regent Management Services will pay $3.2 million to settle allegations that it received kickbacks from ambulance companies in the form of low-cost ambulance transports in exchange for referrals of Regent’s Medicare and Medicaid patients to the ambulance companies.
This is believed to be the first time a nursing home operator, as opposed to an ambulance company, has been held accountable for a “swapping” arrangement. Under such an arrangement, the ambulance company agrees to provide a nursing home or hospital with low-cost ambulance transports when the nursing home or hospital is required to pay for the transports. In return, the nursing home or hospital agrees to refer other patients to the ambulance company when Medicare or Medicaid will pay for the transports. Such “swapping” agreements violate the Anti-Kickback Statute. That law prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals of items or services covered by Medicare or Medicaid. The federal government has made clear that swapping arrangements are an area of concern throughout the ambulance industry, and that it intends to investigate and prosecute these cases aggressively. If you have evidence that an ambulance company is providing low-cost services to a hospital or nursing home in exchange for referrals of Medicare or Medicaid patients back to the ambulance company, then you should consult with an experienced whistleblower lawyer immediately. You may be eligible for a substantial financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. Nurses who once worked for a home healthcare agency will share a $600,000 whistleblower reward for coming forward with evidence of Medicaid fraud by their former employer.
The nurses claimed that their former employer, Deaconess Home Health, Inc., submitted false claims to Medicaid for personal care services. Medicaid generally pays for personal care services to assist patients with daily living activities so they can continue to live at home and not be sent to an assisted living facility or nursing home. The nurses claimed that their former employer recruited patients and personal care workers without regard to whether or not personal care services were medically necessary. The nurses also claimed that their former employer instructed nurses to create false patient assessments to support the Medicaid claims. According to the nurses, their former employer also failed to conduct supervisory visits that are required to ensure that personal care services were actually being provided, that the services were medically necessary, and that the services were appropriate for each patient’s needs. The nurses asserted these claims in a whistleblower or qui tam lawsuit under the False Claims Act. This law allows individuals to start a lawsuit “under seal” (that is, in secret) on behalf of the government and share in any recovery. Once the whistleblower lawsuit is filed, the government must conduct an investigation and decide whether to pursue the lawsuit. If the government recovers money as a result of the whistleblower lawsuit, then the whistleblowers are entitled to a reward of between 15% and 30% of the amount recovered. In this case, the former employer agreed to settle the lawsuit for $3.7 million. The nurses will share in a $600,000.00 whistleblower reward. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. If you want to report your employer for Medicare or Medicaid fraud, you can call a government hotline or you can file a whistleblower lawsuit. Here are some pros and cons for both options.
Calling a hotline is relatively easy and requires very little commitment. You pick up the phone, call a government agency such as the Office of Inspector General at the Department of Health and Human Services, and tell the person at the other end of the line what you know. You can report the fraud anonymously. You do not have to worry about your employer finding out that you reported them to the government for fraud.. The problems with a hotline are: (a) your call by itself will not result in an investigation; and (b) you have no way of knowing what, if anything, was done in response to your call. A single phone call to a government hotline will not lead to an investigation. Government hotlines get so many calls every day that they cannot possibly investigate every call. Anonymous tips, in particular, will not start an investigation because the government has no way to determine whether your tip is substantiated or you are just a disgruntled employee or competitor. The most you can hope for when calling a hotline is that many other people will call with the same complaint against the same employer. A more effective option is to commence a whistleblower lawsuit. This requires a greater commitment on your part, but it is much more effective. The False Claims Act allows individuals to file lawsuits on behalf of the government and share in any recovery. Your lawyer will file the lawsuit "under seal" (i.e., in secret) and will provide your evidence to the government. Once the lawsuit is filed, the government must investigate your claims. If the government needs more than 60 days to investigate your claims, it must ask the Court to "extend the seal" on the case. The government lawyers must inform your lawyer that they intend to ask the Court for more time, and they will usually brief your lawyer on the status of their investigation. Your lawyer can also follow up with the government's lawyers throughout the process for updates. Here's the best part. If the government recovers money as a result of your whistleblower lawsuit, you are entitled to a reward of between 15% and 30% of the amount recovered. In Medicare and Medicaid fraud cases, the rewards can be very large. Many whistleblowers receive hundreds of thousands of dollars in rewards. Some receive millions of dollars in rewards. If you have evidence of Medicare or Medicaid fraud, you should consult with an experienced whistleblower lawyer immediately to protect your rights. The consultation is free and completely confidential. If you and your lawyer decide to proceed with the case, it will be handled on a contingency fee basis -- there are no legal fees unless you win. To schedule a confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. The government has announced a $250 million settlement in whistleblower lawsuits brought against hospitals for submitting false claims to Medicare for cardiac devices implanted in patients.
The whistleblower lawsuits were brought by a cardiac nurse and healthcare reimbursement consultant. As a result of the settlement, they will share a $38 million whistleblower reward under the qui tam or whistleblower provisions of the False Claims Act. The whistleblowers claimed that the hospitals improperly billed Medicare for implantable cardioverter defibrillators or ICDs. These devices monitor the heart for abnormal rhythms and deliver a shock to restore the heart's normal rhythm. They are similar to external defibrillators, only they are implanted in the patient. Medicare pays for ICD surgery only if the patient meets certain criteria. For example, Medicare regulations provide that ICDs should not be implanted in patients until 40 days after a heart attack or 90 days after heart bypass surgery or angioplasty. The whistleblowers in this case claimed that the hospitals were violating the waiting periods, thereby obtaining reimbursement in violation of Medicare regulations and potentially creating health risks for patients. The whistleblowers filed their False Claims Act lawsuits "under seal" (in secret) and provided their evidence to the government. After conducting an investigation, the government decided to pursue the case and negotiated a settlement with the hospitals. Under the False Claims Act, the whistlebowers were therefore entitled to a percentage of the government's settlement as a reward. In this case, the whistleblower reward was $38 million. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. |