Category: Healthcare

Whistleblower Lawsuit Yields Second Largest Medicare Advantage Settlement – $90 Million

Takeaway: This recovery makes it very clear that the federal government and whistleblowers continue to aggressively pursue fraud allegations involving the Medicare Advantage Program. We can expect to see robust enforcement and sizable recoveries to continue.

On August 30, 2021, the United States Department of Justice announced a $90 million settlement with Sutter Health and certain of its affiliates (collectively Sutter Health) relating to allegations that Sutter Health had defrauded the federal government’s huge Medicare Advantage (Part C) Program. 

Speaking of Kickbacks…

Takeaways:

  • Individuals should be wary of the Speaker Programs they choose to attend. Simply attending a Speaker Program where alcohol or an expensive meal is served can be viewed as remuneration in violation of the AKS.
  • HCPs should be extremely selective of the Speaker Programs they choose to participate in.

2020 False Claims Act Recoveries: $2.2 Billion in Recoveries and Over $309M in Awards to Whistleblowers

Takeaways:

  • Over $300 million awarded to whistleblowers.
  • Dip in recoveries reflects pandemic and economic challenges.
  • Number of FCA filings hits a record.
  • Healthcare continues to dominate FCA recoveries with kickbacks a major focus.
  • Rebound in recoveries is likely as defendants regain financial footing.

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 fraud.

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,

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 to a kickback-tainted referral,

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If you are aware of any person, corporation or entity that you think may be violating the Federal False Claims Act or a State False Claims Act, contact us today.

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