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UPS Settles False Claims Allegations for $25 million

The United Parcel Service recently settled allegations of false delivery charges to government agencies for $20 million.
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The Department of Justice issued a groundbreaking press release involving a recent settlement with United Parcel Service, the national logistics company. The May 19, 2015, press release details several allegations involving false billing and invoicing for delivery services.

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Five California Ambulance Companies Settle Fraud Allegations for $11.5 Million

Five Southern California ambulance companies have agreed to pay $11.5 million amid allegations of illegal kickbacks involving Medicare and Medicaid patients.
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On May 4, 2015, the U.S. District Court Southern District of California unsealed a lawsuit filed by a whistleblower alleging illegal kickbacks involving five California ambulance companies and thousands of government healthcare enrollees transported by said companies. Allegedly, the misconduct began in 2009 and involved several serious violations of the state and federal False Claims Act. The lawsuit was filed by a whistleblower who operated a competitor ambulance service provider in the Los Angeles and San Diego areas. Due to his willingness to come forward, he is expected to receive $1.7 million as a reward under the False Claims Act.

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UPDATE: DaVita Health Settles Allegations of Medicare Fraud for $495 Million

After years of litigation, Denver-based DaVita Health has agreed to pay $495 million to settle claims alleging that it defrauded Medicare.
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On the heels of its recent $350 million illegal kickback settlement with the Department of Justice, Denver’s DaVita Healthcare Partners, Inc. has opted to set aside another $495 million to settle additional claims under the False Claims Act involving fraud against government health insurer Medicare.

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The State of Maryland Enhances Its False Claims Act Statute

Maryland lawmakers opted to extend the state False Claims Act beyond just healthcare claims to include any intentional act of fraud against the government.
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More than half of the states within the United States maintain some semblance of a False Claims Act. In some jurisdictions, the False Claims Act identically mirrors the federal version. In other states, the Act is narrower in scope and only pertains to certain types of fraud (e.g., healthcare).

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Manhattan District Attorney Announces $60 Million Settlement with Accredo Over Illegal Kickbacks

U.S. Attorney Bharara recently announced a $60 million settlement with Accredo Health Group amid allegations of illegal kickbacks.
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In a somewhat alarming set of facts, self-proclaimed promoter of “specialty pharmacy solutions” Accredo has agreed to pay $60 million to resolve claims that it engaged in unlawful kickbacks with pharmaceutical company Novartis, Inc.

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Medical Center of Central Georgia to Settle Allegations of Illegal Upcoding for $20 Million

The Macon, Georgia-based Medical Center of Central Georgia has agreed to pay $20 million to settle claims of illegal upcoding.
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Illegal billing practices are one of the most common components of a False Claims Act lawsuit. Oftentimes, healthcare facilities engage in years’ worth of fraudulent billing practices before a courageous whistleblower comes forward with allegations of misconduct. At that time, the federal government may opt to intervene in the matter and the perpetrators may face up to triple damages, as well as fine of up to $11,000 per incident of fraud.

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Office of Inspector General Offers Guidance in Addressing Healthcare Fraud Risk

DHHS OIG offers guidance to avoid healthcare fraud

The DHHS Office of Inspector General recently counseled healthcare governing boards on best practices in identifying and auditing potential risk areas.
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In yesterday’s post, we introduced a recent effort by the U.S. Department of Health and Human Services’ Office of Inspector General, along with several healthcare advocacy groups and agencies, designed to inform and educate healthcare governing boards as to the importance of maintaining thorough compliance measures. We looked at the heightened expectations and standards imposed upon governing boards, as well as the various roles and relationships the OIG considers essential components of a well-run healthcare organization.

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Office of Inspector General Offers Guidance in Avoiding Illegal Billing Practices

The U.S. government’s Department of Health and Human Services’ Office of Inspector General, which is integral in the investigation of healthcare fraud, recently published a guide for hospital governing boards in maintaining strict compliance with Medicare and Medicaid guidelines.
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On April 20, 2015, the DHHS OIG, along with the Association of Healthcare Internal Auditors, the American Health Lawyers Association, and the Healthcare Compliance Association, published a first of its kind educational manual designed to help boards avoid the costly and dangerous practices of upcoding, illegal billing, and submitting false claims.

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Vancouver’s nLight Photonics, Inc. to Settle Allegations of Grant Fraud for $420,000

nLight Photonics accused of grant fraud

Laser manufacturer nLight Photonics has agreed to settle with the U.S. Department of Justice amid allegations of unlawful retention of grant funds from NASA and the U.S. Army.
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Federal grant money can be used in a variety of ways, including research, product development, enhancement of programs, and to fund projects calculated to benefit the public interest. However, grant funds are a limited source funded by taxpayers and are subject to strict eligibility and award criteria. Not only that, a grant recipient can face liability for misusing grant money or improperly documenting how federal grant funds are spent.

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Florida Fertility Clinic Settles Upcoding Allegations with Department of Justice

The Jacksonville Center for Reproductive Medicine is alleged to have “upcoded” several fertility services performed by nurses and medical assistants.Image source: Flickr CC user COD Newsroom

The Jacksonville Center for Reproductive Medicine is alleged to have “upcoded” several fertility services performed by nurses and medical assistants.
Image source: Flickr CC user COD Newsroom

The Jacksonville Center for Reproductive Medicine (JCRM) recently settled with the Department of Justice amid allegations it billed the government for fertility services at rates above and beyond those allowable under TRICARE guidelines.

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