Medicaid or Medicare Fraud

Planned Parenthood affiliates confess to Health and Human Services auditors that they overbilled Medicaid for drugs.

The drugs were purchased through the federal drug discount pricing program and Planned Parenthood allegedly overbilled in several states.

The allegations arose from a lawsuit filed by former Planned Parenthood officers claiming fraud and abuse of Medicaid funds.

Novartis agreed to pay about $390 million to settle kickback claims before the $3.3 billion case went to trial.

The allegations arose when the United States Department of Justice sued Novartis for illegally boosting sales of drugs covered by Medicare and Medicaid programs. Novartis used kickbacks to specialty pharmacies to push sales of some drugs. 

A settlement has been reached to resolve False Claims Act allegations against Millennium Health The whistleblowers' share of the settlement will be $30.35 million from the False Claims Act recovery for the urine drug testing claims and $1.48 million from the False Claims Act recovery for the genetic testing claims. The allegations arose from a lawsuit which claimed that Millennium Health had doctors order unnecessary urine drug tests from January 2008 to May 2015, as well as for false billings related to genetic testing, and for giving free medical supplies to physicians who agreed to refer expensive laboratory testing business to Millennium.

A settlement has been reached in whistleblower class action lawsuits brought against Adventist Health System who is acccused of maintaining improper compensation arrangements with referring physicians and by miscoding claims.

The whistleblowers’ share of the settlement has not yet been determined. 

The allegations arose from two lawsuits, the first of which was filed in December 2012 and claimed that Adventist submitted false claims to the Medicare and Medicaid programs for services rendered to patients referred by employed physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals to Adventist hospitals.  Additionally, the settlement resolves allegations that Adventist submitted bills to Medicare for its employed physicians’ professional services containing certain improper coding modifiers, and thereby obtained greater reimbursement for these services than entitled.

A settlement has been reached in a whistleblower class action lawsuit brought against Planned Parenthood Gulf Coast who is accused of getting paid by government programs for items and services were either not medically necessary, not medically indicated or not actually provided.  

Of the $4.3 million settlement, the federal government will receive $3,594,604 and the State of Texas will receive $705,396. The whistleblower will receive $1,247,000.

The whistleblower lawsuit, originally filed in July 2009, alleged that between 2003 and 2009, Planned Parenthood Gulf Coast billed and was paid by government programs, Texas Medicaid, Title XX, and the Women’s Health Program, for certain items and services related to birth control counseling, STD testing and contraceptives when such items and services were either not medically necessary, not medically indicated or not actually provided.  Title XX is funded by the federal government while Texas Medicaid and the Women’s Health Program are funded jointly by the federal government and the State of Texas.

A settlement has been reached in a whistleblower class action lawsuit brought against The University of Medicine and Dentistry of New Jersey (UMDNJ) who is accused of defrauding Medicaid by submitting duplicate claims for payment.

The whistleblower will receive a $801,000 share of the total federal recovery.

The whistleblwoer case, filed in July 2004, alleged that From 1993 to 2004, UMDNJ’s University Hospital submitted claims to Medicaid for outpatient physician services that were also being billed by doctors working in the hospital’s outpatient centers. By submitting duplicate claims for payment, University Hospital effectively doubled billed the government’s Medicaid program.

A settlement has been reached in a whistleblower class action lawsuit brought against GE Healthcare Inc regarding a company it acquired in 2004, Amersham Health Inc.  Amersham is accused of causing Medicare to make overpayments by providing false or misleading information.

The whistleblower will receive $5.1 million from the government’s recovery.

The whistleblower lawsuit, filed in 2006, alleged that Amersham Health provided false or misleading information to Medicare regarding the number of doses available from vials, causing Medicare to pay for Myoview at artificially inflated rates. Myoview is distributed in multi-dose vials of powder. In a process known as reconstitution, nuclear pharmacies mix the powder with a radioactive agent to prepare individual doses that are injected into patients as part of the cardiac imaging procedures. Certain Medicare payment rates for Myoview were based, in part, on the number of doses available from vials of Myoview.

A settlement has been reached in a whistleblower class action lawsuit brought against Medtronic Inc who is accused of using physician payments related to post-market studies and device registries as kickbacks to induce doctors to implant the company’s pacemakers and defibrillators.

The settlement resolves allegations contained in two whistleblower lawsuits. The whistleblowers will receive payments totaling more than $3.96 million from the federal share of the recovery.

The United States alleged that Medtronic caused false claims to be submitted to Medicare and Medicaid by using two post-market studies and two device registries as vehicles to pay participating physicians illegal kickbacks to induce them to implant Medtronic pacemakers and defibrillators. Although Medtronic collected data and information from participating physicians, each of the studies and registries required a new or previous implant of a Medtronic device in each patient, and in each case Medtronic paid participating physicians a fee ranging from approximately $1,000 to $2,000 per patient. The United States contends that Medtronic solicited physicians for the studies and registries in order to convert their business from a competitor’s product and/or persuade the physicians to continue using Medtronic products.

A settlement has been reached in a criminal lawsuit brought against Maxim Healthcare Services Inc who is accused of defrauding Medicaid programs and the Veterans Affairs program of more than $61 million. 

The settlement requires payment of approximately $130 million to Medicaid programs and the Veterans Affairs program to resolve False Claims Act liability for false home healthcare billings to Medicaid programs and the Veterans Administration under civil agreements relating to this matter. Maxim has agreed to pay a criminal penalty of $20 million. 

The settlement resolves allegations that Maxim billed for services that were not rendered, services that were not properly documented, and services performed by 13 unlicensed offices. Maxim has agreed to pay approximately $70 million to the federal government and approximately $60 million to 42 states.

The whistleblower will receive approximately $15.4 million as his share of the recoveries from the federal government and the states.

The criminal complaint, filed in September 2011, accuses Maxim, a privately-held company based in Columbia, Md., with hundreds of offices throughout the United States, of submitting more than $61 million in fraudulent billings to government health care programs for services not rendered or otherwise not reimbursable. The investigation revealed that the submission of false bills to government health care programs was a common practice at Maxim from 2003 through 2009. During that time period, Maxim received more than $2 billion in reimbursements from government health care programs in 43 states based on billings submitted by Maxim.

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A settlement has been reached in a whistleblower class action lawsuit brought against Kmart Corporation who is accused of using improper Medicare beneficiary inducements.

The whistleblower will receive approximately $248,500 of the settlement.   

The whistleblower case, filed in October 2013, alleged that Kmart violated the False Claims Act by providing illegal inducements to beneficiaries of the Medicare program.  The government alleged that from June 2011 to June 2014, Kmart knowingly and improperly influenced the decisions of Medicare beneficiaries to bring their prescriptions to Kmart pharmacies by permitting the Medicare beneficiaries to use drug manufacturer coupons to reduce or eliminate prescription co-pays that they otherwise would be obligated to pay.  Federal law prohibits a person from offering beneficiaries of certain federal health programs, such as Medicare, remuneration that is intended to influence the beneficiary’s choice of provider.  The government alleged that Kmart’s conduct caused the Medicare beneficiaries to seek expensive, brand name drugs in lieu of cheaper generic drugs, which caused the government’s costs to increase without any medical benefit to the beneficiary.  The government also alleged that Kmart improperly encouraged Medicare beneficiaries to bring their prescriptions to Kmart pharmacies by offering them varying levels of discounts on the purchase of gasoline at participating gas stations based on the number of prescriptions that they filled at Kmart pharmacies.