Healthcare Fraud Lawyer Blog

November 9, 2015

Cheat the System, Pay the Price: Pursuing Those Who Knowingly Violate Medicare Rules

There are few topics that will get people talking (and, inevitably, complaining) like health insurance. The truth of the matter is that, in order to function efficiently and provide the best possible care to the largest possible audience, health insurance companies must have rules and guidelines. Perhaps the context where this principle is most important is when the insurer is Medicare. According to a government memo published in July marking the program’s 50^th year, Medicare currently covers 55 million beneficiaries, an increase of 3 million beneficiaries from just three years ago. While coverage rules are sometimes unpopular, they exist for a reason and organizations that repeatedly bill and collect money in violation of Medicare coverage rules put the system and all who rely on it in jeopardy. The government cannot examine every claim in depth making health care fraud whistleblowers critical to protecting the system, one of the many reasons we are proud to serve as a Medicare fraud whistleblower’s law firm.

Settlement Resolves Allegations 450+ Hospitals Violated Medicare Guidelines for Cardiac Devices

On October 30, the Department of Justice (“DOJ”) announced that it had reached 70 related settlements totaling over $250 million dollars resolving allegations that 457 hospitals (listed in a separate document) in 43 states violated Medicare rules related to implantable cardiac devices. Most of the hospitals were named as defendants in a lawsuit filed under the False Claims Act (“FCA”) which contains a special qui tam provision allowing private whistleblowers to file claims on the government’s behalf. In this case, the original suit was filed by a cardiac nurse and a health care reimbursement consultant. Pursuant to the FCA, the whistleblowers received over $38 million from the settlement. While some might suggest that amount seems excessive, as the legal news website Lawyers and Settlements notes, “when the depth and breadth of the alleged healthcare fraud is factored in, it soon becomes clear the contributions of the two lead plaintiffs were integral in what has been described as one of the largest examples of alleged healthcare fraud, in terms of the number of defendants, in the history of the False Claims Act (FCA).”

November 2, 2015

Health Care Fraud Attorney on the Importance of Treating Patients as Individuals with Individual Needs

by Gregory J. Brod

It’s something you learn in preschool, but sometimes it seems like a lesson modern medicine has forgotten – Everybody is unique (and that’s a good thing!). Medicine should be tailored to individual patient’s needs; after all, that’s why we go to the doctor individually rather than showing up with thirty others and being handed the same treatment as everyone else. Sometimes, however, companies forget this and often profit seems to be the motivating factor. Using overly generalized profiles to justify unnecessary, costly tests and/or treatments can be a form of health care fraud. The law empowers both patients and conscientious professionals to fight these misdeeds, wrongs that can be both costly and dangerous. As a whistleblowers’ law firm specializing in health care fraud, The Brod Law Firm can help. Together, we can bring an end to unnecessary billing based on general profiles and ensure medicine focuses on the individual.

Lab Company Settles Claims it Billed for Unnecessary, Generalized Services

On October 19, the United States Department of Justice (“DOJ”) issued a press release announcing the settlement of multiple False Claims Act lawsuits against Millennium Health, a company headquartered in California. Millennium agreed to pay $256 million to resolve claims they billed Medicare, Medicaid, and other federal programs for services that were not medically necessary and allegations they provided free items to medical practitioners in exchange for their use of company services. While the settlement resolves the legal claims in several whistleblower suits, Millennium did not admit any wrongdoing.

October 26, 2015

Health Care Fraud Lawyer on Pill Restocking and Other Pharmacy Fraud Schemes

by Gregory J. Brod

As consumers of health services, we rely on medical professionals to help us protect our own health and the health of others. The vast majority of medical professionals are dedicated to providing the best care possible. Sadly, however, there are some people who abuse the public’s trust, often risking the health and welfare of others for personal gain. Today’s post will focus on pharmacies and pharmacy fraud, a category that includes pill restocking schemes. These schemes may include Medicare fraud, Medicaid fraud, and/or fraud on private insurance providers. People who become aware of such schemes, including patients, pharmacy employees, and other medical professionals, can help fight back. As a pharmacy fraud law firm, we work with concerned citizens to stop these crimes and protect the health of innocent Americans.

Restitution Order in Alleged Pill Restocking Case

Last week, according to WZZM13, a federal judge handed down an order for restitution in a case that has already let to more than a dozen arrests. WZZM reports that, according to this ruling, the drug restocking scheme cost Medicare over $64 million and cost Medicaid $18.2 million with an additional $4.7 million lost by Blue Cross Blue Shield of Michigan. The ruling decrees that the CEO and six others must collectively pay $8.8 million, 10% of the total amount lost by public and private insurers due to the fraud.

October 19, 2015

Spotlight on Government Contracts Fraud: The Danger of Overcharging and Other Frauds Involving Military Contracts

by Gregory J. Brod

We are lucky to live in a nation where men and women are willing to put their lives on the line, forming a volunteer military that protects our country and its people. In turn, we all must help support this military and help keep them safe. This is why our firm is taking part in the fight against defense contractor fraud. A number of well-publicized aviation tragedies makes a case involving a major aircraft manufacturer particularly concerning, even if the allegations are focused on military planes and allege overbilling rather than underperforming. Tolerating one form of fraud almost ensures other cases will follow, possibly including companies taking dangerous shortcuts. It is more important than ever for private citizens come forward and partner with experts like our defense contracts fraud lawyer to fight government fraud in all forms — there is often far more than just money at stake.

Aircraft Manufacturer Pays $18 Million to Settle Claims of Overcharging on Defense Contracts

Last Wednesday, the U.S. Department of Justice (“DOJ”) issued a press release announcing that The Boeing

October 12, 2015

Off-Label Marketing – Using the False Claims Act to Fight Improper Drug Promotion

by Gregory J. Brod

If you take medication regularly, why do you take it? Why that specific medicine? Hopefully, the answer is that you take it for a genuine medical need and, along with your doctor and pharmacist, you chose that specific medication because it is the best fit for your medical needs. A lot of attention has been paid in recent years to how money intrudes on medicine, specifically people’s inability to afford the medicines they need. However, money also intrudes in other ways as shown by the long story of Risperdal and the allegations of improper marketing of pharmaceuticals. This is yet another area in which the False Claims Act (“FCA”) can be used to combat health care fraud and our pharmaceutical marketing fraud law firm is prepared to be part of this fight.

The Case of Johnson & Johnson and the $2.2 Billion Settlement

One of the longest Department of Justice (“DOJ”) press releases we’ve read on FCA claims dealt with one of the largest FCA settlements — Johnson & Johnson’s (“J&J”) agreement to pay $2.2 billion to settle a variety of claims involving off-label marketing and kickbacks. The settlement includes both criminal and civil allegations. The claims largely surround the drug Risperdal which, for most of the time involved, was approved only for the treatment of schizophrenia.

October 5, 2015

Using the False Claims Act to Hold Financial Institutions Accountable for the Mortgage Crisis

by Gregory J. Brod

Mortgage lending may not be in the spotlight in 2015 to the same degree it was a few years ago, but it remains an important element of our economy and mortgage fraud was partially responsible for the recession that rocked the globe in the first decade of the millennium. Although many associate the False Claims Act (“FCA” or “the Act”) with health care fraud, its reach is much broader and includes certain forms of mortgage fraud. When banks grant federally insured/guaranteed mortgages that do not meet program requirements and the government has to pay out money due to a default, an FCA suit can be appropriate. As with other FCA claims, private citizens can play an important role in these actions by sharing information about suspected fraud and partnering with our mortgage fraud whistleblower’s lawyer to hold financial institutions responsible for the consequences of granting risky loans.

$212.5 Million Settlement in Mortgage Fraud Case

On June 1, the Justice Department (“DOJ”) issued a press release detailing a recent False Claims Act settlement in the mortgage fraud arena. As background, the press release explains that First Tennessee Bank (along with its affiliates and successors) participated in the FHA Direct Endorsement Lender (“DEL”) program from January 2006 through October 2008. Pursuant to the DEL program, neither the Federal Housing Administration (“FHA”) mortgage nor the Department of Housing and Urban Development (“HUD”) reviewed program loans, instead relying on First Tennessee to follow program rules and self-report any deficiencies.

September 28, 2015

Ensuring Health Care Decisions Based on Patients’ Best Interest, Not Provider Profits

by Gregory J. Brod

The relationship between health care and money is the crux of some of the biggest policy debates of our time. Still, while much is debated, there are also many principles that most Americans agree should hold true. One such maxim – Medical decisions should be based on the best interests of patients, not providers own financial well-being. This precept is reflected in several laws including the Anti-Kickback Statute and the Stark Act and enforcing these rules is one of the goals of our work as a whistleblowers’ law firm for health care fraud issues.

$115 Million Settlement Resolves Case Alleging Health System’s Bonuses Violated Law

Just last week, the Justice Department (“DOJ”) announced a major settlement in a health care fraud case involving allegations of improper financial relationships between health care providers and their referral sources. The lawsuit claimed that Adventist Health Systems, a healthcare organization with facilities in 10 states, billed for the services of employed providers who were paid bonuses that, contrary to law, were based on a formula that considered the value of the referrals to the hospital system. More specifically, the suit alleged that doctors received monetary bonuses tied to the number of tests and procedures they ordered. Adventist agreed to pay $115 million to settle these and other fraud allegations, but did not admit to any wrongdoing.

September 21, 2015

The Many Uses of the False Claims Act: Beyond Medicare Fraud and Military Contracts

by Gregory J. Brod

As a False Claims Act law firm, we are always interested to find out what people know about the law, a fundamental issue given the large role private citizens play in bring False Claims Act (“FCA” or “the Act”) lawsuits. One of the things we’ve learned is that even the people who are familiar with the law are surprised to learn the wide variety of contexts in which it can apply. Likewise, its many state counterparts are versatile tools for the fight against fraud.

Overview of the False Claims Act

The Legal Information Institute (“LII”) at Cornell University Law School explains that the FCA is a “[f]ederal statute setting criminal and civil penalties for falsely billing the government, over-representing the amount of a delivered product, or under-stating an obligation to the government.” Although not emphasized in the LII article, false claims only violate the Act if made knowingly, with deliberate ignorance, or willful disregard of the claim’s falsity (see The False Claims Act: A Primer published by the Department of Justice (“DOJ”)).

September 14, 2015

Who Brings Government Fraud Whistleblower Claims?

by Gregory J. Brod

We frequently write about healthcare fraud and other forms of government contract fraud. We cannot overemphasize the role that whistleblowers play in prosecuting these cases. According to the Justice Department, nearly $3 billion of the $5.69 billion recovered through settlements and judgments in civil False Claims Act (“FCA”) litigation in Fiscal Year 2014 stemmed from qui tam lawsuits filed by private whistleblowers. Who are these whistleblowers? In some cases, they are high-ranking executives in companies that committed fraud. However, whistleblowers can also be “rank and file” employees, the “everyday” workers who form the majority of any large operation, or even company outsiders. Our law firm for government fraud whistleblowers works with people from all ranks of society who take step forward and join the fight against fraud.

Settlement In Suit Brought By Medical Technician

Last month, the Sacramento Bee reported that Quest Diagnostics agreed to pay $1.8 million to settle Medicare fraud claims. According to the allegations, Quest submitted duplicate claims for Medicare reimbursement for the same test performed on a single day and a single patient. A Quest spokesperson suggested IT issues caused rare cases of duplicate payments impacting a “miniscule percentage” of the company’s annual Medicare claims and said Quest is updating its billing systems to prevent a recurrence.

September 7, 2015

Whistleblower Litigation: Fighting Drug Promotion Plots Involving Many Active and Passive Participants

by Gregory J. Brod

No matter how long we serve as a law firm for Medicare fraud matters, we continue to be appalled by the nature of these crimes. These crimes often involve more than just shifting money into the perpetrators’ wallets. Medicare fraud often directly impacts the care beneficiaries receive or, in some cases, the care they don’t receive. We are also disturbed by the number of people involved in certain frauds like the wide-ranging scheme to profit from prescribing unneeded medications to nursing home residents. While there are often more active participants than we’d like to imagine (i.e. more people willing to risk others’ well-being for profit), many more are silent observers. It is these individuals who have the most power when it comes to fighting fraud – they can become the whistleblowers in False Claims Act whistleblower litigation.

A Drug Marketing Scheme Involving Numerous Companies and Individuals

Earlier this year, The Kentucky Center for Investigative Reporting examined a plot to profit from using pushing the (over)use of certain medications by nursing home residents. To understand the schemes, one needs to know that specialized companies operate nursing home pharmacies. These providers, including PharMerica and Omnicare “occupy a strategic place in the flow of drugs to nursing home patients,” buying medications from pharmaceutical manufacturers and often repackaging them in foil packs referred to as “bingo cards” before dispensing them to nursing home residents via the company’s consulting pharmacists.