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Whistleblower Law Blog

Topic: Medicare Fraud

Ghoulish Medicare Fraudster Admits Giving Chemo to Healthy Patients

Just weeks before a planned trial, Michigan oncologist Farid Fata pleaded guilty to 16 of 23 criminal counts, including charges of giving chemotherapy to healthy patients in order to get Medicare payments.

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Cardiology Group Will Pay $1.3 Million to Settle Claims of Improper Referrals

The U.S. Department of Justice (DOJ) said it obtained a $1.3 million settlement of allegations that a cardiology practice violated the False Claims Act and the Stark Act by knowingly compensating its physicians based on the number of tests that the physicians referred.

The Stark Act prohibits a physician from referring Medicare patients for designated health services to an entity with which the physician has a financial relationship (unless an exception applies). The Stark Act does not permit a practice to compensate a physician based directly on the volume or value of the physician’s referrals for services not personally performed by the ordering physician.

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Whistleblower Nurse Reaps $15 Million Reward in Amedisys Fraud Settlement

The U.S. Department of Justice announced settlements with several healthcare companies accused of fraud — including a massive $150 million deal with Amedisys Inc. in which the government resolved seven lawsuits with the giant homecare provider, leading to more than $26 million in payouts to whistleblowers and a jackpot for U.S. taxpayers.

The largest whistleblower reward, more than $15 million, went to April Brown, an Alabama nurse and single mother who was fired by Amedisys after she questioned its Medicare billing practices.

» Read more

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March Whistleblower Rewards Include $500,000 in Cargo Price-Fixing Case

The U.S. Department of Justice announced settlements in three large qui tam cases during March — including a price-fixing case where the whistleblower earned a half-million-dollar reward.

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After Blowing Whistle on Itself, Utah Hospital Chain Agrees to Pay $25.5 Million

Utah’s Intermountain Healthcare Inc. will pay $25.5 million to settle claims that it violated federal laws, including the Stark Law against profit-driven referrals by doctors.

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University of California Pays $1.2 Million to Settle Medicare Fraud Claims

The University of California will pay $1.2 million to settle a whistleblower’s claims that one of its teaching hospitals submitted false Medicare and Medicaid claims.

Dennis O’Connor, a former professor and anesthesiologist at U.C. Irvine (UCI), will receive $120,000 for his role in the case; the remainder goes to the U.S. government. In his lawsuit, Dr. O’Connor alleged that UCI routinely gave patients anesthesia without a doctor being present, in violation of federal requirements.

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Arizona Hospice Will Pay $12 Million to Settle Claims It Treated Ineligible Medicare Patients

An Arizona hospice company will pay $12 million to settle charges that it bilked Medicare by inflating bills and admitting patients who weren’t ready for end-of-life care.

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Fairfax Nursing Center Pays $700,000 Settlement for Submitting False Claims for Medicare Reimbursement

Fairfax Nursing Center (FNC), a skilled nursing facility in Fairfax, Virginia, and its owner have agreed to pay $700,000 to settle allegations of submitting false claims to Medicare for non-reimbursable rehabilitation therapy services. The False Claims Act lawsuit was filed in the U.S. District Court for the Eastern District of Virginia by two former FNC therapists and one former contract therapist.

The lawsuit alleges that between January 2007 and December 2010, in order to capture higher reimbursements from Medicare, FNC provided excessive, medically unnecessary, or otherwise non-reimbursable physical, occupational, and speech therapy to thirty-seven Medicare patients. Furthermore, the services that were rendered were unreasonable and completely unnecessary for the treatment of the patients’ conditions.

Stuart F. Delery, Principal Deputy Assistant Attorney General for the Civil Division of the Department of Justice, stated:

“Today’s settlement is another example of the Department’s efforts to hold skilled nursing facilities accountable for the rehabilitation therapy services they deliver to some of the most vulnerable in our society… The provision of excessive and medically unnecessary therapy services will not be tolerated.”

The Employment Law Group® law firm’s whistleblower attorneys have helped many clients file suit against employers that fraudulently bill the U.S. government, and have established favorable precedents under the retaliation provision of the False Claims Act.

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Medicare False Claims Result in $900,000 Settlement by Baylor University

Baylor University Medical Center, Baylor Health Care System and HealthTexas Provider Network (collectively, “Baylor”) have agreed to pay a $907,355 settlement for allegedly submitting false claims and double billing Medicare, the Civilian Health and Medical Program of the Uniformed Services (TRICARE) and the Federal Employees Health Benefit Program (FEHBP) between 2006 to May 2010.

According to the Department of Justice, Baylor submitted false claims for several radiation treatments, and billed for high-reimbursement  oncology procedures when it could have billed cheaper services. Additionally, Baylor submitted billing for procedures lacking the required supporting documents in the patient’s medical records and improperly billed for radiation services without adequate corroboration from physician supervisors.

Stuart F. Delery, Principal Deputy Assistant Attorney General for the Justice Department’s Civil Division, said:

“Physicians who participate in Medicare must bill for their services accurately and honestly… The Department of Justice is committed to ensuring that federal health care funds are spent appropriately.”

This lawsuit is part of an ongoing effort by the Department of Justice and the Department of Health and Human Services to combat medical billing fraud under the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative.

The Employment Law Group® law firm’s whistleblower attorneys have helped many clients file suit against employers that fraudulently bill the U.S. government, and have established favorable precedents under the retaliation provision of the False Claims Act.

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New York Hospital to Pay $7M to Settle Qui Tam Suit Alleging Medicaid Billing Fraud

New York’s Westchester Medical Center has agreed to pay $7 million to settle a lawsuit brought by Richard Anderson, the administrative head of Westchester’s behavioral health center.  Anderson filed his qui tam suit alleging Medicaid fraud in July 2011.

From August 2001 to June 2010, the mental health center at Westchester Medical Center allegedly billed Medicaid for millions of dollars for outpatient services without the proper documentation such as the required progress reports and treatment plans. Although the hospital was aware that it did not provide the required documentation with submitted claims, it did not take action to address the problem until after an audit by the New York State Department of Health inspector general in 2010. Even after the audit uncovered fraud, the hospital did not return the funds to Medicaid.

When discussing this Medicaid lawsuit on Wednesday, Preet Bharara, U.S. Attorney for the Southern District of New York, said, “We have absolutely no tolerance for those who fail to comply with the program, particularly in these lean times when budgets are stretched thin and belts are being tightened.”

The Employment Law Group® law firm has an extensive nationwide whistleblower practice representing employees who have been victims of retaliation.

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