Posted by Stephanie R. on Friday, August 7th, 2015
False claims occur in virtually every aspect of federal contract work. In today’s case, we look at a recent multi-faceted settlement, the details of which have been ongoing for most of 2015, involving relocation services for U.S. military members. The case was brought to light by several employees of the moving companies after noticing suspicious billing practices with regard to the weight of the freight hauled under the government contract. The overall settlement topped $1.2 billion, and the most recent component of the agreement was reached between the defendant – Covan World Wide Movers, Inc. – and the District of South Carolina, where the company maintains several offices and hubs.
Posted by Stephanie R. on Thursday, August 6th, 2015
In yesterday’s post, we introduced a possible correlation between the growth of Medicare spending on highly-addictive prescription drugs and potential Medicare fraud by wayward retail pharmacies. As a bit of review, spending for Medicare Part D administration has increased 136 percent overall since 2006. However, spending for opioids – including OxyContin and Morphine – has increased over 156 percent within the same time period, leaving authorities to inquire as to how or why spending in this area has increased so rapidly.
Posted by Stephanie R. on Wednesday, August 5th, 2015
Over the next two posts, we will examine a recent report published by the Office of Inspector General, along with the U.S. Department of Health and Human Services. In the report, which is entitled “Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D,”1 authorities review the alarming epidemic of drug diversion and prescription drug abuse, particularly among the elderly population eligible for Medicare benefits.
- http://oig.hhs.gov/oei/reports/oei-02-15-00190.pdf ↩
UPDATE: Georgia Hospital Settles Amid Allegations of Unlawful Kickbacks in Exchange for Obstetric Referrals
Posted by Stephanie R. on Tuesday, August 4th, 2015
In 2014, we covered the government’s decision to intervene in a False Claims Act lawsuit involving several Central Georgia-area hospitals and possible Medicaid fraud. As a bit of review, the case involved several hospitals, including Tenet Healthcare, Health Management Associates, and Clinica de la Mama, an OB/GYN facility geared toward undocumented and migrant Hispanic women.
Posted by Stephanie R. on Monday, August 3rd, 2015
An indexed universal life insurance policy is a financial product designed to offer policyholders a variable return rate on their insurance funds, usually tied to the daily rates as set by entities like Standard & Poor’s. More specifically, these policies – which are predominantly similar to traditional universal life insurance policies – allow policyholders to allocate cash values to certain equity index accounts with the goal of achieving maximum possible returns and, ultimately, a higher yield for the insurance policy beneficiary.
Posted by Stephanie R. on Thursday, July 30th, 2015
In one of the largest potential whistleblower settlements1 to date, drug maker Novartis is facing a staggering $3.35 billion in fines and penalties from the Department of Justice over two of its best-selling prescription medications: Exjade and a treatment for kidney transplant patients. In a separate concurrent whistleblower lawsuit against the “repeat offender,” a whistleblower has alleged that the company wrongfully promoted two high-potency cancer drugs known to cause severe side effects. Overall, the company is looking at a historic penalty and possible exclusion from all further participation in federal and state healthcare insurance programs.
- http://taf.org/blog/costly-kickbacks-novartis-potentially-faces-3-billion-fines ↩
Posted by Stephanie R. on Tuesday, July 28th, 2015
In 2013, we covered a historic False Claims Act verdict entered by the U.S District Court for the District of South Carolina against Tuomey Healthcare System. In that case, a whistleblower-physician alleged that the company was requiring doctors to agree to referral schemes that violated both the False Claims Act and the Stark Law, as kickbacks are expressly prohibited under both statutes.
Posted by Stephanie R. on Monday, July 27th, 2015
Government contract work can be extremely lucrative, providing companies with a regular stream of income and dependable job security for their employees. Accordingly, the risk for rampant fraud and abuse of taxpayer resources is also very common, particularly when it comes to adhering to the ironclad provisions in the government’s contractual agreements.
Posted by Stephanie R. on Friday, July 24th, 2015
When it comes to reimbursement for surgical procedures, Medicare and Medicaid maintain strict guidelines with regard to the location of the surgery and whether it took place in a hospital or independent facility. Recognizing that hospitals have a much higher overhead rate, and generally cost more to operate and maintain, surgical procedures performed in a hospital setting can be reimbursed at a higher rate than those performed in an office or ambulatory surgical center.
Posted by Stephanie R. on Thursday, July 23rd, 2015
Proving that healthcare fraud truly knows no bounds, the Children’s National Medical Center – through its Children’s Hospital Medical Graduate Program – is accused of engaging in costly and wasteful healthcare fraud involving various pediatric patients enrolled in the Medicaid program. Consequently, the hospital has agreed to pay a staggering $12.9 million in lieu of defending the claims, but has not admitted to any wrongdoing in the matter.