Category: Healthcare

Study Shows U.S. Gets $16 For Every $1 Spent Fighting Healthcare Fraud

According to the organization, Taxpayers Against Fraud (“TAF”), the federal government receives over $16 for every $1 it spends investigating and prosecuting civil healthcare fraud.  This is even after subtracting the amount paid to whistleblowers.

Under the False Claims Act (“FCA”), healthcare fraud cases have grown significantly. Just 62 healthcare qui tam cases were recorded from 1987 to 1992 but 412 were recorded for last year alone.

Kmart To Pay $2.55M For FCA Fraud

The Kmart discount chain, in order to settle False Claims Act complaints, has agreed to pay $2.55 million.

Kmart violated the False Claims Act by billing Medicaid, the Federal Employee Health Benefits Program, and other health programs for all drugs included in a prescription in cases when it dispensed only part of the prescribed drugs. 

South Carolina’s Tuomey Healthcare System Ordered To Pay $277 Million For Stark, FCA Violations

A federal judge ordered South Carolina’s Tuomey Healthcare System to pay $277 million for violating laws that bar hospitals from paying doctors to refer Medicare patients for treatments.  The ruling – a result of the denial of Tuomey’s post-trial motions and the granting of the government’s request to impose Stark Penalties and False Claims Act fines – is believed to be the largest of its kind against a community hospital in U.S.

Government Hit With Sanctions For “Apathetic Conduct”

In a ruling meant in part to keep the government from benefitting from its “apathetic conduct”, a New Mexico federal judge upheld a magistrate judge’s recommendation for sanctions against the government for failing to safeguard documents that may have aided Community Health Systems (CHS) in defending against a whistleblowers Medicaid claim.

Scheme Settled For $26 Million Under False Claims Act

Venice dermatologist Steven J. Wasserman will pay $26 million to the federal government for claims of Medicare fraud under the False Claims Act.  It was alleged that he accepted illegal kickbacks from pathologist Jose SuarezHoyos, owner of Tampa Pathology Laboratory.  Allegedly, Wasserman would send Medicare patients’ biopsy specimens for analysis and diagnosis to TPL. 

Hospital Self-Reports Overbilling To Federal Government And Agrees To Pay $4.9 Million In Restitution

Catholic Health Initiatives, previous owner of St. Joseph Medical Center, will pay the federal government $4.9 million because it kept Medicare and Medicaid patients in the hospital longer than was necessary.  The company based in Denver, owns hospital around the county.  Previously and unrelated to the current settlement, the medical company was involved in lawsuits from hundreds of patients who accused star cardiologist at St.

Cooper Health System Pays $12.6 Million To Resolve False Claims Lawsuit Over Kickbacks Paid To Referring Physicians

A federal lawsuit filed by prominent Delaware Valley cardiologist Nicholas L. DePace, M.D., sparked a multi-year investigation by the United States Department of Justice and the New Jersey Attorney General’s Office that has resulted in New-Jersey based Cooper Health System, and Cooper University Hospital paying $12,600,000 to settle Medicare and Medicaid fraud allegations. 

Provision In Fiscal Cliff Bill Windfall For Amgen

Despite recently pleading guilty in a major Medicare fraud case, Amgen, the world’s largest bio-technology company, received a major gift from Congress in its “fiscal cliff” bill—a delay in Medicare price restraints on a class of drugs that includes Amgen’s profitable Sensipar pill.

Under the provision, Amgen will be able to continue to sell Sensipar,

Judge Shoots Down Proposed Settlement Of Health System Criminally Charged With Fraud

U.S. District Court judge Terrence Boyle rejected a proposed settlement and deferred prosecution agreement by WakeMed Health and Hospitals, a North Carolina health system criminally charged with ripping off Medicare for at least $1.2 million.  The first hospital or health system to be criminally charged with defrauding Medicare, WakeMed Health and Hospitals allegedly made false statements to Medicare in order to be reimbursed for costly inpatient stays of Medicare patients who never actually were inpatients at the hospital. 

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