Category: Medicare

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. 

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.

International Whistleblowing Legislation and America’s False Claims Act

This is the second part of a two-part article.

In the first of this two-part series, we discussed the success of the United States’ federal False Claims Act (FCA),[1] the rise of international whistleblowers through a study of the Michael Epp case,

United States Files False Claims Act Complaint Against Vanguard Healthcare

The United States has filed a False Claims Act case against Tennessee-based nursing home company, Vanguard Healthcare LLC, as well as Vanguard Healthcare Services LLC, and six of its nursing facilities. See United States vs. Vanguard, et al., case no. 3:16-cv-2380 (M.D.Tenn 2016). The lawsuit alleges that the defendants were responsible for the submission of false claims to Medicare and TennCare (Tennessee’s Medicaid program) for skilled nursing home services that were either non-existent or grossly substandard. 

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