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Wheeling Jesuit University to Pay $2.3 Million to Settle Allegations of Federal Grant Fund Misuse

Wheeling Jesuit University grant fraud

West Virginia’s Wheeling Jesuit University has agreed to repay the funds it wrongfully misused under NASA’s grant program.
Image source: Wikimedia Commons

Unfortunately, fraud within universities is not uncommon, and today’s case highlights a growing trend of grant fund misuse. Located in the mountains of West Virginia, Wheeling Jesuit University has agreed to pay $2.3 million it is alleged to have misused, all of which was provided by the National Aeronautics and Space Administration (NASA) for purposes of research and development.

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Tennessee Hospital Agrees to Settle Allegations of False Billing and Unlawful Practices

The Regional Hospital of Jackson has agreed to pay $510,000 to settle allegations it engaged in medically unnecessary cardiac procedures and false billing.

Of the various ways in which healthcare providers can violate the False Claims Act, ordering medically unnecessary procedures – particularly those involving the cardiac system – are considered particularly egregious. As opposed to illegal upcoding or kickback schemes, the performance of medically unnecessary procedures actually places patients directly in harm’s way, and all for the purpose of increasing profit margins.

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Government Accountability Office Alerts Congress to Medicare & Medicaid Eligibility Issues

The Government Accountability Office has highlighted a significant percentage of care providers who may actually be ineligible for enrollment under Medicare and Medicaid guidelines.
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In fiscal year 2014, American taxpayers footed a $554 billion dollar bill for Medicare and Medicaid – two programs that, while essential in nature, are exceedingly strapped for resources. As one of the hallmark goals of the False Claims Act, authorities have worked diligently to ensure providers are billing correctly only for those services actually rendered, or major fines and penalties will ensue.

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D.C. Circuit Court Upholds ‘Implied Certification Theory’ in Recent False Claims Act Case

A case recently decided in the D.C. Circuit Court involved the implied certification theory.
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In yesterday’s post, we explored the concept of implied certification under the False Claims Act – a theory which somewhat eliminates the requirement for explicit false claims activity, but requires evidence that the defendant knew or should have known his activity did not comply with a government contract, but continued to submit invoices nonetheless.

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‘Implied Certification’ Theory and the False Claims Act

Implied certification is an oftentimes confounding legal theory under the False Claims Act.
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Over the next two posts, we will examine a concept known as “implied certification.” This legal theory has been a part of the False Claims Act landscape for several years and has caused considerable discussion among the circuit courts as to the extent an implied theory works to hold a false claims defendant liable.

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Federal Government Examines Helicopter Manufacturer Sikorsky Amid Allegations of Fraud

Sikorsky Aircraft is accused of defrauding the government with regard to a 2006 U.S. Navy contract.
Image source: Wikimedia Commons

Aside from healthcare fraud, defense contractor fraud remains one of the top forms of waste and abuse addressed by the False Claims Act. Too often, big-budget defense contracts serve as fodder for dishonest companies to inflate and exaggerate costs, resulting in unnecessary spending of an already-strained defense budget.

In one recent defense contractor case, the federal government has begun a probe of Sikorsky Aircraft, a defense contractor having previously provided helicopters to the U.S. Navy under a 2006 contractual agreement. The investigation is pursuant to a False Claims Act lawsuit filed last year against Sikorsky’s parent company, United Technologies Corp., which was revealed in the latest filings required by the SEC for purposes of alerting investors as to potential liability and issues.

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Berger & Montague, P.C. Settles Whistleblower Lawsuit Involving AstraZeneca, Cephalon, & BioGen, Inc.; Secures $55 Million on Behalf of Taxpayers

AstraZeneca settles lawsuit

AstraZeneca, Cephalon, Inc., and BioGen, Inc. have agreed to pay $55 million to settle allegations of unlawful billing practices with regard to Medicaid prescriptions.

As one of the leading and most successful whistleblower law firms in the United States, Berger & Montague, P.C. is pleased to announce its involvement in a $55.5 million settlement involving three major players in the pharmaceutical industry. This past July, Berger & Montague, P.C. announced the settlement against AstraZeneca, Cephalon, Inc., and BioGen, Inc. – three of the largest medication-makers in the world. Specifically, our law firm was integral in securing a victory on behalf of our client, who vows that his quest for victory is far from over.

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Improper ‘Balance Billing’: Examples of a Rising Trend

balance billing

For patients seeking care from an out-of-network doctor, costs can increase dramatically – and, in some cases, illegally.
Image source: Wikimedia Commons

In yesterday’s post, we introduced an emerging concept known as “balance billing,” which results in skyrocketing medical expenses and increased medical debt for unsuspecting patients. As a brief review, balance billing occurs when a patient seeks treatment from an out-of-network doctor, who then bills the patient for the maximum allowable charges – which are often much higher than the maximum allowable charges for the same treatment in-network. Moreover, doctors are inviting other out-of-network doctors to participate in patient care without the patient’s knowledge or consent, as we will illustrate in today’s post.

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Emerging Fraud Trends: The Rise of Balance Billing

Balance billing

Calculating medical bills can be very difficult in the face of balance billing, which is becoming a major problem for patients.
Image source: Wikimedia Commons

At Berger & Montague, P.C., we strive to keep on top of the latest emerging trends in the fraud landscape, particularly when the misconduct drives up the costs of healthcare for policyholders and taxpayers alike. Over the next two posts, we will examine an emerging fraud trend known as “balance billing,” which our firm has tackled head-on and will fight against on behalf of our courageous clients and whistleblowers.

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Judge Orders Near-Maximum Whistleblower Reward; Cites ‘Indispensable Contribution’

whistleblowerImage source: Flickr CC user frankieleon

In a contentious False Claims Act lawsuit, a U.S. judge has upheld a 24% whistleblower reward for a relator it deemed indispensable to the investigation.
Image source: Flickr CC user frankieleon

One of the key components of the success of the False Claims Act is its ability to incentivize whistleblowers to come forward by offering up to 30 percent of the total settlement in some cases. In today’s post, we examine an interesting holding by the U.S. District Court for the Eastern District of Pennsylvania, which upheld a 24 percent whistleblower reward over the Department of Justice’s strenuous objections.

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