Medicaid

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 two whistleblower class action lawsuits brought against Kos Pharmaceuticals, a subsidiary of Abbott Laboratories, who is accused of paying illegal kickbacks to doctors, other medical professionals, physician groups and managed care organizations to get them to prescribe or recommend Niaspan and Advicor.

According to the agreement reached with the government, the Delaware-based company will pay more than $38 million to settle civil allegations under the False Claims Act and a $3.36 million criminal fine. The federal share of the civil settlement is $33,705,310 and the state Medicaid share is $4,454,432.The whistleblowers will receive payments totaling more than $6.4 million from the federal share of the civil recovery. 

The first of the two cases was filed in March 2004 and alleged that between January 2002 and June 2006, two doctors proposed that they would endorse the use of Kos products, including Advicor, for the treatment of cholesterol in exchange for a series of payments. During that time, one of the doctors wrote 4,130 prescriptions for Kos products. According to the court documents, some of those prescriptions were paid for by Medicare and Medicaid. From 2002 to 2004, Kos made a series of payments to the two doctors or a third party intermediary in the form of “sponsorship” of continuing medical education classes conducted by the doctors and purported speakers’ fees. 

If you have a similar case please fill out the form below or email mail@whistleonfraud.com or call: 619 - 866 – 6157

OR

If you or someone you know experienced a similar situation or any other wrongdoing within a corporation you should contact mail@whistleonfraud.com or call: 619 - 866 – 6157

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.

If you have a similar case please fill out the form below or email mail@whistleonfraud.com or call: 619 - 866 – 6157

OR

If you or someone you know experienced a similar situation or any other wrongdoing within a corporation you should contact mail@whistleonfraud.com or call: 619 - 866 – 6157

A settlement has been reached in a whistleblower class action lawsuit brought against Jackson-Madison County General Hospital who is accused of overbilling Medicare and Medicaid for certain cardiac procedures.

The whistleblower's portion of the settlement was not disclosed.

The lawsuit, filed in 2007, alleged that Jackson-Madison County General Hospital placed cardiac stents in patients when the procedure was not required, together with other cardiac procedures that were deemed not medically necessary. The hospital, according to allegations stemming from an investigation and a whistleblower healthcare fraud lawsuit, then billed Medicare and Medicaid.

A settlement has been reached in a whistleblower class action lawsuit brought against John D. Archbold Memorial Hospital Inc who is accused of submitting false claims to the state of Georgia’s Medicaid program.

The whistleblower will receive $695,151 from the settlement amount.

The whistleblower case, filed in 2008, alleged that between November 2002 and July 2008, the Thomasville, Ga.-hospital made false representations to the Georgia Department of Community Health, the state agency that administers the Medicaid program in Georgia, that it was a public hospital for Medicaid purposes in order to increase the amount of Medicaid funds provided to the hospital. Under Medicaid rules, only public hospitals may participate in the Medicaid Upper Payment Limit (UPL) program. In addition, public hospitals receive additional Disproportionate Share Hospital (DSH) program funds that are not available to private hospitals. Contrary to its certification to the Georgia Department of Community Health, Archbold Memorial was in fact a private hospital, and as a result received millions of dollars in UPL and DSH funds to which it was not entitled.

A settlement has been reached in two whistleblower class action lawsuits brought against Schwarz Pharma Inc who is accused of causing false claims to be submitted to federal health care programs.

The federal share of the settlement is $12,243,836 and the state Medicaid share is $9,756,164. The two whistleblowers will receive a total of $1,836,575 from the federal share and additional amounts from the state share.

The United States allegations were in reference to Schwarz Pharama Inc's drugs, Deponit and Hyoscyamine Sulfate Extended Release (Hyoscyamine Sulfate ER). 

Deponit is a nitroglycerin skin patch that has been used to prevent angina. Hyoscyamine Sulfate ER is an antispasmodic medication that has been used to treat various stomach, intestinal, and urinary tract disorders that involve cramps, colic, or other painful muscle contractions. While the active ingredients in Deponit and Hyoscyamine Sulfate ER had been in products on the market for many years, the Food and Drug Administration made determinations in 1997 and 1999 that resulted in the drugs being ineligible for reimbursement by government health care programs such as Medicaid.

The United States alleged that Schwarz misrepresented the regulatory status of both drugs and failed to advise CMS that these unapproved drugs did not qualify for coverage under federal health care programs. As a result, the government contends, Schwarz knowingly caused false claims to be submitted for Deponit and Hyoscyamine Sulfate ER. Ultimately, neither Deponit nor Hyoscyamine Sulfate ER ever received full regulatory approval for safety and effectiveness, and neither product is currently on the market.

A settlement has been reached in a whistleblower class action lawsuit brought against FORBA Holdings LLC who is accused of causing bills to be submitted to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid.

FORBA will pay $24 million, plus interest. The federal share of the civil settlement is $14,285,645, and the states’ Medicaid share is $9,714,355.25. Three whistleblowers will receive payments totaling more than $2.4 million from the federal share of the settlement.

The case stems from three lawsuits that were filed by individual whistleblowers. The United States alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, and providing fillings and/or sealants.

A settlement has been reached in a whistleblower class action lawsuit brought against three home health agencies.   Nursing Personnel Home Care (Nursing Personnel), Extended Home Care (Extended) and Excellent Home Care (Excellent) are accused of submitting false claims to the New York Medicaid and Medicare programs.

The United States is receiving approximately $9.7 million as a result of the settlement with these three companies, and the state of New York is receiving approximately $14.3 million, for a total recovery of $24 million. The settlement resolves allegations from two different lawsuits filed by whistleblowers. One of the whistleblowers will receive $251,107 from the government’s recovery from Nursing Personnel. The other whistleblower's reward is $1,663,040 from the government’s recovery from Extended and Excellent.

The first of the two lawsuits was filed in 2006.  The United States alleged Nursing Personnel Home Care (Nursing Personnel) knowingly supplied aides with phoney training certificates to Extended Home Care (Extended) and Excellent Home Care (Excellent), which then billed New York Medicaid for the aides’ services; that Extended and Excellent knowingly billed for aides with phoney certificates who were untrained; and that Extended and Excellent knowingly submitted claims to the Medicare program for home health aide services purportedly rendered by aides supplied by Nursing Personnel that were not actually provided.

A settlement has been reached in a whistleblower class action lawsuit brought against Visiting Physicians Association who is accused of submitting false claims to Medicare, TRICARE and the Michigan Medicaid program.

The lawsuit was one of four filed against the defendants.  The whistleblowers will share in a recovery of approximately $1.7 million.

The United States alleged that Visiting Physicians Association submitted claims to the Medicare, TRICARE and Michigan Medicaid for unnecessary home visits and care plan oversight services, for unnecessary tests and procedures, and for more complex evaluation and management services than the services that Visiting Physicians Association actually provided.