Category: Healthcare

Calling Insiders With Information on Pandemic Fraud, Waste & Abuse

On April 16, 2020, the Honorable William M. McSwain, United States Attorney for the Eastern District of Pennsylvania, issued a sweeping request for help in identifying companies and individuals who seek to “exploit the devastating effects of the coronavirus pandemic for their own benefit.” The Philadelphia United States Attorney’s Office has a long history fighting […]

Genetic Testing Gold Rush Gives Rise To Fraud Allegations

On Sept. 27, the U.S. Department of Justice announced criminal charges against 35 individuals across various jurisdictions, allegedly involved in genetic testing fraud schemes that cost taxpayers over $2.1 billion. The government asserted that the individuals had engaged in audacious schemes to target seniors and the disabled through the ordering of cancer genetic screening, or […]

Why the European Union Whistleblower Laws Are All Doomed To Fail

As seen on the EU blog, LawHealthTech.com: Member States of the European Union, over the last several years, have passed a series of so-called “Whistleblower Laws.”  These laws are being implemented allegedly to bolster anti-corruption efforts throughout Europe.  While corruption is no stranger to either side of the Atlantic, the European Union would advance their […]

Ex-BlueWave Execs and Former HDL CEO Hammered with $111 Million Judgment

What Happened? On May 23, 2018, the U.S. District Court for the District of South Carolina, Judge Richard M. Gergel, imposed a $111 million judgment against former Health Diagnostics Laboratory (“HDL”) CEO, Latonya Mallory, and former BlueWave Healthcare Consultants (“BlueWave”) owners, Floyd Dent III and Robert Bradford Johnson. Mallory, Dent, and Johnson, who had been […]

When Is a Kickback Not a Kickback? Third Circuit Says It Must Be Linked to Specific False Claim

What Happened? In affirming the district court’s entry of summary judgment in favor of Accredo Health Group, Inc., and its co-defendants, the U.S. Court of Appeals for the Third Circuit held that a plaintiff alleging a False Claims Act (“FCA”) violation based on an anti-kickback theory must show that (1) a particular patient was exposed […]

4th Circuit Finds Misrepresentations about Medical Necessity for Urinalysis Testing are Material

The United States Court of Appeals for the Fourth Circuit has affirmed a District Court’s judgment on a husband and wife’s health care fraud convictions.  The Appellate Court found that medical necessity was a “critical prerequisite to payment” and insurers would not have knowingly paid for medically unnecessary urine drug tests. Joseph Webb and Beth […]

Georgia-based Hospital Group to Pay Over $513 Million to Resolve Civil and Criminal Allegations Related to Illegal Payments for Patient Referrals

On Monday, the DOJ announced the resolution of criminal allegations and a False Claims Act (“FCA”) lawsuit a relating to a scheme to defraud the United States and obtain kickbacks in exchange for patient referrals.  A major U.S. hospital chain, Tenet Healthcare Corporation and two subsidiaries, Atlanta Medical Center, Inc. and North Fulton Medical Center, […]

$34.8 Million to be Paid by Respironics for False Claims Related to Sale of Sleep Apnea Masks

Respironics is to pay $34.8 million for alleged False Claims Act violations related to the sale of sleep masks designed to treat sleep apnea.  Allegedly Respironics, a Murrysville, PA based company, paid kickbacks in the form of free call center services to durable medical equipment (DME) companies that purchased the masks.  The DME companies; otherwise, […]

2014 Whistleblower Recoveries

In 2014, the total whistleblower recoveries amounted to just shy of $3 billion, $2.2 billion (73 percent) of which were in the health care arena. When the Department of Justice announces a False Claims Act recovery, they put the total recovery into the headline (the total amount that the fraudster is paying as a result […]

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