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Dickson Medical Associates to Pay $500,000 to Settle Prescription Fraud Claims

Prescription fraud in Tennessee

Tennessee-based medical group accused of procuring non-approved, foreign-manufactured medications in violation of the Food, Drug and Cosmetic Act.
Image source: Wikimedia Commons

The False Claims Act has proven extremely successful in combating wasteful healthcare fraud. In fact, fiscal year 2014 proved so far to be the most lucrative year in terms of healthcare fraud settlements and verdicts. To trigger possible liability under the False Claims Act, a whistleblower must allege that certain state or federal regulations were violated by a government contractor, followed by submissions of invoices or claims for reimbursement. Hallmarks of healthcare fraud include violations of Medicare and Medicaid regulations including sub-standard care, overbilling for medically unnecessary procedures, or submitting claims for reimbursement for procedures that never occurred.

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UPDATE: Federal Court Dismisses Six Affirmative Defenses in Lance Armstrong False Claims Act Lawsuit

Lance Armstrong

Disgraced former cycling hero Lance Armstrong recently suffered a major blow to his False Claims Act case after a Washington D.C. federal court dismissed six of his affirmative defenses.
Image source: Wikimedia Commons

The federal False Claims Act can apply to just about any act of fraud involving taxpayer dollars, including the systematic abuse of government funds at the hands of a wayward cycling team – headed by none other than the disgraced former Tour de France champion Lance Armstrong. In 2013, a former teammate of Armstrong’s initiated a whistleblower lawsuit under the False Claims Act, alleging the cyclists intentionally submitted false claims for reimbursement to the government for purposes of funding his U.S. Postal Service racing team despite consistently utilizing banned performance enhancing drugs. This was a clear violation of not only the rules of cycling, but also of the agreement between Armstrong and the federal government for the provision of the funds.

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Alabama District Court Weighs Relator Confidentiality Against Rights of the Public

relator confidentiality


In a recent whistleblower lawsuit, an Alabama court considered whether the identities of two relators should be indefinitely concealed from public identification.
Image source: almd.uscourts.gov

When it comes to False Claims Act lawsuits, there are a number of confidentiality protections in place that are not generally required in a typical civil lawsuit. For instance, relators are required to file their lawsuit under seal and keep the details of the claims confidential until the defendant has been served or the lawsuit is dismissed. Likewise, the government must maintain strict confidentiality when implementing its initial investigation into the matter, primarily to avoid tipping off the defendant before an investigation begins in earnest.

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CA Contractors to Pay $4 Million to Settle False Claims Act Allegations & Wage Disputes

CA contractors

California-based contractors Arbon and Rite-Hite have agreed to pay $4 million after a whistleblower revealed the companies were not paying workers proper wages as required by federal laws.
Image source: Wikimedia Commons

In a recent False Claims Act settlement, California contractors Arbon and its subsidiary Rite-Hite have agreed to pay $4 million to settle claims of unlawful wage practices involving its employees. Under the False Claims Act, it is considered a violation for a contractor to breach the terms of its agreement with the government and thereafter submit claims for reimbursement. If this occurs, anyone with original knowledge of the scheme can commence a whistleblower lawsuit, which not only exposes the fraud but can result in a sizable reward for the whistleblower relator.

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Lake Shore Medi Car Transit Faces $500,000 False Claims Act Settlement for Medicaid Fraud

Medicaid fraud

Illinois-based Lake Shore Medi Car Transit has agreed to pay $500,000 to settle claims of Medicaid fraud.
Image source: ilnd.uscourts.gov

The Medicaid program is a need-based health insurance program run by the federal and state governments. In most instances, the federal government matches state funding dollar-for-dollar. However, states generally have latitude in determining the type, extent and frequency of services covered. In Illinois, certain medical transport services (aside from emergency ambulance or air transport) may be covered for eligible Medicaid enrollees, provided certain criteria are met and the situation makes it medically necessary for the patient to receive medical transport. However, as today’s case reveals, transport companies often skirt various federal regulations in an effort to increase profits and maximize billing, which will quickly trigger False Claims Act liability under both state and federal laws.

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Testosterone Clinic Ageless Men’s Health Pays $1.6 Million in False Claims Act Settlement

A testosterone clinic known as Ageless Men’s Health has agreed to pay $1.6 million to settle claims of billing for medically unnecessary procedures. The clinic is based in Memphis, Tennessee.
Image source: Wikimedia Commons

In yet another healthcare fraud settlement, Tennessee-based Ageless Men’s Health has been targeted by the Department of Health and Human Services, as well as the Department of Justice, for fraudulently billing Medicare and TRICARE for medically unnecessary male hormone therapy services.

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Optometry Practice Settles False Claims Act Allegations Regarding Medically Unnecessary Exams

optometry practice false claims act

A Pulaski County optometry office has agreed to settle claims of fraudulent billing practices for $800,000.
Image source: Wikimedia Commons

When it comes to unlawful billing practices settled under the False Claims Act, nursing homes and long-term care facilities are frequently implicated in fraudulent misconduct with regard to the various services they offer to residents. In today’s case, the federal government recently reached a settlement with Kentucky-based Associates in Eye Care following an investigation that revealed the provision of medically unnecessary services to various long-term care patients across the state.

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Minnesota-based Medtronic, Inc. to Settle False Claims Involving Off-Label Marketing

Medtronic, Inc. has agreed to pay $2.8 million to the federal government in order to settle claims it unlawfully marketed its spinal therapy products for uses unapproved by the FDA.
Image source: Wikimedia Commons

Medtronic, Inc. – a company familiar with false claims allegations – has agreed to pay $2.8 million to settle claims it unlawfully induced physicians and medical practitioners to use its spinal neuromodulation devices to treat conditions not considered by the FDA when the product was granted approval. This dangerous and risky practice is known as off-label marketing and is frequent fodder for False Claims Act liability.

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EV3 Slapped with Whistleblower Lawsuit After Giving Bad Billing Advice

A medical device manufacturer allegedly induced hospitals to buy its products by promising procedures using its blood vessel products could be billed as inpatient.
Image source: Wikimedia Commons

Medical device manufacturer EV3, an owner of the subsidiary Covidien, Inc., has agreed to pay $1.25 million to settle a False Claims Act lawsuit brought about following allegations it intentionally offered fraudulent billing advice to hospitals with regard to the use of its atherectomy products. The case was settled after a lengthy investigation, which was commenced upon the filing of a whistleblower lawsuit by a former sales representative for the company prior to its recent merger. For her troubles, the whistleblower is set to receive 20 percent of the settlement amount, or $250,000.

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Green Bag Co. Inc., Settles False Claims Act Allegations Involving Customs Avoidance

Green Bag, Inc. evaded customs payments

Green Bag Co., Inc., manufacturer of environmentally-friendly reusable shopping bags, has agreed to pay $500,000 to settle claims it unlawfully evaded customs payments.
Image source: Wikimedia Commons

One of the world’s largest manufacturers of eco-friendly reusable shopping bags has settled claims it unlawfully evaded customs payments by using a complex invoicing scheme designed to intentionally defraud the government out of money. Following a whistleblower lawsuit filed by a former executive with Green Bag Co., Inc., investigators from the U.S. Attorney’s Office for the Northern District of California and the DHS Office of Inspector General revealed that the company had engaged in potentially unlawful customs avoidance activity and eventually settled the matter. Green Bag, Inc. did not admit any liability or wrongdoing on its part and the relator received $100,000 for his willingness to come forward with the allegations of fraud.

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