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Recognizing ‘Worthless Services’ Under the False Claims Act

Worthless services claims FCA

Claims of ‘worthless services’ are arising with increasing frequency within the context of Medicare and Medicaid fraud.
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When it comes to committing fraud against Medicare and Medicaid, there are a number of ways for doctors, hospitals, and medical companies to get around the rules. Some encourage billing specialists to “upcode” for higher reimbursement rates, essentially billing Medicare or Medicaid for services never rendered. Others, quite alarmingly, perform unnecessary medical services, including surgeries and invasive procedures, in order to pad profits.

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DOJ’s Motion to Reopen PharMerica Whistleblower Case Highlights Critical FCA Issues

Despite having reached a settlement in September, the DOJ has motioned to reopen the whistleblower case against PharMerica, citing several ongoing disputes.
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False Claims Act cases often conclude with a negotiated settlement between the Department of Justice (DOJ), defendant(s), and the relator(s). However, settlements are complex matters that contain a number of terms and provisions unique to each individual case.

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SEC Settles Fraud Case Regarding Restrictive Language with KBR, Inc.

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The SEC recently settled its first whistleblower case involving overly-restrictive language in confidentiality agreements.
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Whistleblowers with knowledge of possible securities fraud are able to report this fraud confidentially under the relatively new whistleblower provisions of the 2010 Dodd Frank Act. If an employee opts to report the information directly to the government, he or she is thereafter protected from retaliatory maneuvers by the employer and can even seek additional damages if any adverse employment action is taken.

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Mortgage Fraud Allegations Unsealed Against Ocwen and Wells Fargo

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A recently-unsealed False Claims Act lawsuit reveals plaintiffs’ allegations involving the wrongful default of home loans.
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Mortgage fraud continues to be one of the top areas of recovery under the False Claims Act, with allegations stemming from the many of the blunders of 2008 just recently reaching a settlement. In a recent mortgage fraud case involving loan servicer Ocwen and lender Wells Fargo, two borrowers are alleging a “default fraud” scheme in which both entities wrongfully classified the loan as in default in order to collect double fees and penalties. The allegations were filed in September 2014, and were recently unsealed following the government’s decision not to intervene.

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Off-Label Marketing Becomes Global Issue as World Health Organization Encourages Cost-Effectiveness

The WHO is examining the benefits of off-label marketing and has urged corporations to work together to lower the costs of medication overall.
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Amid global shortages of life-saving medical resources, the United Nations’ World Health Organization has released a report focusing on various cost-saving tactics for member nations to consider while strategizing medical policy. At the heart of the matter, the WHO found that most nations do not have procedures in place to evaluate cost-effectiveness of current medical treatments, making it more difficult to envision solutions for the global health crisis.

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Department of Education Yanks Funding From Several ‘Risky’ Colleges and Universities

The Department of Education is looking to reduce misuse of federal funding by unscrupulous colleges and universities, many of which are alleged to have misguided students into enrolling by using inflated employment success rates.
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Over the past several years, a number of colleges and universities have faced significant fines, penalties, and liabilities for unlawfully inducing students into enrolling using falsified or exaggerated graduation and employment data or by paying recruiters by the enrollee. For instance, several U.S. law schools were named in a recent lawsuit alleging employment and bar passage rates were inflated to entice students to enroll, ultimately costing students thousands of dollars in tuition fees for an inferior legal education.

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Litigation Advances in Parallel False Claims Act Cases Against Walgreens

National pharmacy chain Walgreens is facing serious allegations of submitting false claims to Medicare and Medicaid, according to allegations raised in two California cases.
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Walgreens Pharmacy has been in business for over 100 years, but its century-long business presence cannot insulate it from the onslaught of False Claims Act allegations raised by several California pharmacists alleging serious violations of state fraud laws.

In today’s post, we look at two recent milestones in the ongoing False Claims Act litigation against the pharmacy chain, including contentions of illegal coding practices, as well as misconduct involving the marketing of gift cards toward customers receiving Medi-Cal and Medicare benefits for prescription drug coverage.

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Robinson Health System to Pay $10 Million to Settle Illegal Kickback Allegations

Ohio’s Robinson Health System agreed to a $10 million settlement over illegal kickbacks to physicians.
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The U.S. Attorney’s Office for the Northern District of Ohio recently negotiated a $10 million settlement with Robinson Health System amid allegations of illegal kickbacks. The defendant is a health system management company, which operates a non-profit entity in Portage County, Ohio. The settlement comes on the heels of several other settlements involving providers in the area, including a settlement with Portage Hospital itself several weeks ago.

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Millennium Pharmaceuticals Escapes False Claims Act Allegations; Judge Leaves First Amendment Arguments Intact

In a closely-watched False Claims Act off-label marketing lawsuit, one of three defendants – Millennium Pharmaceuticals – has escaped liability.
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The ongoing off-label marketing debate has given rise to several False Claims Act lawsuits commenced by a single whistleblower. In a qui tam cause of action filed in November, 2009, whistleblower Frank Solis has alleged that Millennium Pharmaceuticals and Merck, Inc. engaged in the controversial sales technique known as off-label marketing with regard to several prescription medications.

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Adventist Health Settles Allegations It Failed to Supervise Radiologists

Adventist Health System has agreed to settle claims it did not properly supervise oncology radiology procedures.
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In a recent healthcare fraud settlement, Adventist Health System – Sunbelt Healthcare Corporation has agreed to pay $5.4 million to settle allegations it improperly billed Medicare and Medicaid for radiology services. The settlement concludes an investigation conducted by the U.S. Attorney’s Office for the Middle District of Florida, the Civil Division’s Commercial Litigation Branch, and the U.S. Department of Health and Human Services’ Office of Inspector General. The lawsuit that prompted the investigation was commenced by a Florida-based radiation oncologist and former employee of Florida Oncology Network, P.A., an Adventist Health System participant. In exchange for his willingness to come forward, the whistleblower is set to receive $1,085,100 as a qui tam reward.

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