Articles Posted in Medicaid

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The fraud was exposed by two former company executives who filed a qui tam lawsuit under the False Claims Act. They will share a whistleblower award of $8.3 million.
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Pennsylvania-based cardiac monitoring company BioTelemetry, Inc. (Nasdaq: BEAT) and its subsidiary CardioNet LLC have agreed to pay nearly $45 million to resolve allegations they violated the False Claims Act by knowingly billing federal healthcare programs for services performed by cardiovascular technicians located outside the United States in violation of federal law.

According to the U.S. Department of Justice, the companies also violated the False Claims Act by knowingly billing federal healthcare programs for work performed by technicians who lacked required training and certification.

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iStock-465505283-300x200The fraud was exposed by a former ModMed executive who filed a qui tam lawsuit under the False Claims Act. He will receive a $9 million whistleblower award.

Florida-based electronic health records firm Modernizing Medicine has paid $45 Million to resolve allegations it violated the False Claims Act by paying and receiving kickbacks in violation of the Anti-Kickback Statute.  According to the U.S. Department of Justice, ModMed partnered with pathology lab firm Miraca Life Sciences to jointly promote ModMed’s cloud-based EHR software and Miraca’s pathology laboratory services through illegal kickbacks.

Miraca previously paid $63.5 million to settle False Claims Act allegations relating to the scheme, which was exposed by a whistleblower who filed a lawsuit under the qui tam provisions of the False Claims Act.  The whistleblower—a former ModMed product manager—will receive a whistleblower award of $9 million in connection with the ModMed settlement.

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The lawsuit is part of an effort by the U.S. Justice Department to investigate and litigate fraudulent diagnosis-coding practices by Medicare Advantage (Part C) insurers

 The U.S. Department of Justice has announced that it has sued health insurance company Cigna Corporation (NYSE: CI), alleging that it violated the False Claims Act by knowingly submitting false and invalid diagnosis codes to artificially inflate the capitation payments it receives from Medicare in connection with its Medicare Advantage health insurance plans.  The DOJ complaint-in-intervention was filed in a lawsuit initiated by a qui tam whistleblower under the False Claims Act.

The case is part of an ongoing effort by the DOJ to investigate and litigate improper diagnosis coding by private insurers operating Medicare Advantage (Part C) health plans.

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iStock-1153436387-300x199The settlement follows Cardinal Health’s payment of $13M to resolve related False Claims Act allegations earlier this year

A Florida medical group has paid $130,000 to resolve allegations it violated the Anti-Kickback Statute (AKS) and False Claims Act by knowingly taking illegal kickbacks from pharmaceutical distributor Cardinal Health (NYSE: CAH).  The settlement, by the U.S. Department of Justice with Southeast Florida Hematology and Oncology Group, follows Cardinal Health’s payment of $13.1 million back in January to settle related False Claims Act allegations.

The scheme was exposed by two qui tam whistleblowers—a former Cardinal Health executive and a different medical practice in Florida that dealt with the drug distributor.  They shared $2.6 million of the Cardinal Health settlement as a whistleblower award.

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Manufacturer of home respiratory equipment allegedly coaxed DME suppliers to recommend and buy more of its products by furnishing them with two types of kickbacks—HMS prescription data and loan guarantees

Philips Respironics, a subsidiary of the Netherlands-based Koninklijke Philips N.V. (NYSE: PHG) and a leading manufacturer of home respiratory equipment, has agreed to pay $26 million to settle two qui tam lawsuits alleging it violated the Anti-Kickback Statute (AKS) and False Claims Act by furnishing kickbacks to durable medical equipment suppliers.

The qui tam relator whose complaint exposed the bulk of the fraud will receive a $4.3 million whistleblower award.

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iStock-1297234647-1-300x200Biogen allegedly spent millions illegally inducing doctors to prescribe its multiple sclerosis drugs

The Boston-based pharmaceutical company Biogen Inc. (NasdaqGS: BIIB) has agreed to pay $900 million to resolve a qui tam whistleblower’s claims that it paid neurologists “massive” kickbacks to coax them to prescribe its drugs for the treatment of multiple sclerosis.  The kickbacks—which included millions of dollars in sham speaking and consulting fees—allegedly violated the Anti-Kickback Statute and the False Claims Act.

Marketing executive receives record $250 million whistleblower award
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Qui tam whistleblower alleged that Bayer fraudulently paid kickbacks, conducted off-label marketing, and hid safety risks

Bayer, the U.S. division of the German drug giant Bayer AG (OTC: BAYRY), has agreed to pay a total of $40 million to settle a pair of False Claims Act whistleblower lawsuits alleging that it illegally marketed three drugs.  According to the lawsuits, Bayer illegally paid kickbacks to doctors, promoted off-label uses, and downplayed safety risks.  The qui tam whistleblower—a former Bayer marketing research analyst—will receive an $11 million whistleblower award from the settlement proceeds.

Illegal off-label marketing and downplaying of risks
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Biotronik allegedly paid doctors illegal kickbacks to promote the sale of its implantiStock-1182459087-1-300x210able cardiac devices

Medical device manufacturer Biotronik has agreed to pay $12.95 million to settle allegations that it violated the False Claims Act through payment of illegal kickbacks to physicians as part of an effort to market and promote its implantable cardiac devices, including pacemakers and defibrillators. Two former sales executives of the company who exposed the fraud by filing a qui tam lawsuit will share a whistleblower award of $1.25 million.

A multi-pronged kickback scheme
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Athenahealth allegedly violated the Anti-Kickback Statute (AKS) and False Claims Act by paying kickbacks for clients referrals

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Healthcare technology firm Athenahealth has agreed to pay $18.25 million to settle allegations it violated the False Claims Act by paying illegal kickbacks for client referrals as part of initiatives to promote its Electronic Health Records platform athenaClinicals. Two qui tam relators whose whistleblower complaints exposed the fraud stand to receive significant whistleblower rewards.

Three illegal “marketing” initiatives