Skip to Content

Blog

Controversial Staten Island Doctor Settles Medicare Fraud Case for $2.35 Million

Medicare fraud at Staten Island University Hospital

A former oncology physician at the Staten Island University Hospital has agreed to pay over $2 million to settle claims of Medicare fraud resulting from investigative cancer treatments.
Image source: Wikimedia Commons

A New York City physician – known infamously for asking Beatles member George Harrison to sign a guitar on his deathbed – has recently agreed to settle a Medicare fraud lawsuit. Dr. Gil Lederman, who agreed to pay $2.35 million to settle the False Claims Act allegations, has categorized the allegations as a “legal nightmare,” and has vowed to continue the practice of medicine despite almost losing Medicare privileges as a result of the fraud investigation. The lawsuit, which was filed ten years ago by the widow of a patient treated by Dr. Lederman, alleges Dr. Lederman used his experimental cancer treatments on the decedent and thereafter sought reimbursement in violation of the Medicare guidelines at the time. As a result of her willingness to come forward, the whistleblower is expected to receive $326,250 and $175,000 toward her legal bills.

Continue reading…

Pain Management Physician Agrees to Pay $1.2 Million to Settle False Claims Allegations

A Valencia-based physician affiliated with the Henry Mayo Newhall Hospital has agreed to pay $1.2 million to settle claims of upcoding and medically unnecessary procedures.
Image source: Wikimedia Commons

As we previously reported, the Department of Justice was able to recover over $2 billion on behalf of taxpayers defrauded by healthcare providers engaging in misconduct against Medicare and Medicaid in fiscal year 2014. As part of this recovery, a Valencia, California-based doctor has agreed to pay $1.2 million to resolve allegations of unlawful billing procedures and the intentional submission of false invoices for reimbursement. The case was unsealed along with 68 other False Claims Act complaints, several of which involved similar healthcare fraud and billing scams.

Continue reading…

Eleventh Circuit Tackles Contentious Rule 9(b) Issue

Eleventh Circuit - Rule 9(b)

The Eleventh Circuit recently upheld a whistleblower case despite a lack of specific evidence of intentional fraud.
Image source: Wikimedia Commons

As we have reported in a previous post, Florida-based Health Management Associates, Inc. is facing extreme liability under the False Claims Act stemming from allegations that emergency room physicians were offered kickbacks and financial incentives for admitting a certain number of patients per day – notwithstanding the lack of medical necessity for inpatient care. On appeal, HMA is seeking redress from the United States Court of Appeals for the Eleventh District – particularly with regard to the applicability of Federal Rule of Civil Procedure 9(b).

Continue reading…

California State Court Orders New Trial Following California False Claims Act Verdict

Recology in False Claims Act case

San Francisco-based Recology, a waste management company, is facing possible liability for inflating the weight of its reimbursable recyclable trash collection.
Image source: Wikimedia Commons

California, along with many other states, maintains its own False Claims Act statute that closely mirrors the language of the federal version. The lengthy, comprehensive, statute allows private individuals to file claims under the Act if that person has original knowledge of the submission of a false claim to any government entity in the state of California. It has proven especially helpful in combatting fraud involving Medi-Cal (the state’s Medicaid program), charities, consumers, business issues, and natural resources.

Continue reading…

California Court Dismisses Whistleblower Lawsuit Due to Insufficient Facts in Complaint

USC University Hospital

USC University Hospital was able to dodge a whistleblower lawsuit by asserting the relator did not properly plead facts sufficient to withstand a motion for summary judgment.
Image source: Wikimedia Commons

In the context of False Claims Act lawsuits, there is much to be said about the initial complaint stage. As you recall, Circuit Courts of Appeal are split as to the level of specificity required for a False Claims Act filing. Some courts have concluded that Federal Rule of Civil Procedure 9(b) (hereinafter, “Rule 9(b)”) is to be strictly construed to require evidence of each and every instance of fraud. Other courts have concluded that the rule is not to be read so stringently, and evidence to support an inference of fraud is sufficient.

Continue reading…

Oklahoma Dentist Settles False Claims Act Allegations Involving Medicaid Patients

Dental services company settles False Claims Act allegation of upcoding.

A dental services company has agreed to pay $5 million to settle claims of illegal upcoding in dental services provided to Medicaid patients.
Image source: Wikimedia Commons

In a rare False Claims Act settlement involving dental care, an Oklahoma-based dentist has agreed to pay $5 million to settle claims of false invoices to the federal government for dental services. The company, which actually operates facilities in seven U.S. states, is alleged to have engaged in the familiar practice of unlawful upcoding and billing for services never rendered. The case actually did not involve a whistleblower, but was investigated by a concerted effort between the Federal Bureau of Investigation, the U.S. Department of Health and Human Services, Office of Inspector General, the Oklahoma Attorney General’s Office Medicaid Fraud Control Unit, and the Oklahoma Healthcare Authority. The case was prosecuted by Assistant United States Attorneys Ronald R. Gallegos and Scott Maule, and Oklahoma Assistant Attorney General Niki S. Batt.

Continue reading…

CareAll Companies Agree to Pay $25 Million in False Claims Act Settlement

A Tennessee home-based healthcare provider has agreed to pay $25 million to the federal government and State of Tennessee.
Image source: Wikimedia Commons

In yet another instance of costly and wasteful healthcare fraud, CareAll Management, LLC has agreed to pay $25 million to resolve allegations of illegal upcoding and falsification of information on official requests for reimbursement. In the context of healthcare fraud, the False Claims Act is triggered whenever an invoice is submitted for repayment on behalf of Medicare or Medicaid patients and that invoice contains intentionally false information. The False Claims Act, which has been around since the 1800’s, has proven especially helpful in recent years as over $23 billion has been recovered on behalf of federal healthcare programs. Many states have enacted legislation similar to the federal False Claims Act, allowing state authorities to pursue fraud against the state-run portion of the Medicaid program and other state-level benefits agencies.

Continue reading…

Visiting Nurse Service Settles Alarming Long-Term Healthcare Fraud Allegations

Healthcare fraud and US Attorney

Manhattan U.S. Attorney Preet Bharara recently settled allegations that New York’s Visiting Nurse Service billed Medicaid for long-term care services when patients were actually receiving adult day care assistance.
Image source: Wikimedia Commons

For individuals in need of long-term care (i.e., a permanent stay in a nursing home), the options are to either self-fund the monthly charge or to apply for Medicaid benefits. As Medicare does not cover long-term care, patients in need of this vital service must be eligible by showing financial hardship and a lack of personal assets. Once eligibility is established, Medicaid will generally cover the costs of long-term care so long as the patient is in need of such skilled nursing services. Similarly, Medicaid may also cover the costs of in-home care in the event the patient is considered homebound and suffering from a severe medical condition wherein a visiting nurse is necessary.

Continue reading…

Contractor Agrees to Pay $2.72 Million to Settle False Claims Act Allegations in EPA Fraud Case

Several environmental contractors are facing civil and criminal liability for falsifying expenses relating to the cleanup of the federal Creosote Site.
Image source: Wikimedia Commons

In a rare False Claims Act settlement involving the Environmental Protection Agency, a superfund contractor has agreed to pay $2.72 million to resolve various allegations involving misconduct by employees. Under the False Claims Act, any person with original information about fraud involving federal funds may come forward under the False Claims Act’s qui tam  provisions. If successful, the whistleblower could receive up to 30 percent of the ultimate settlement or verdict. Most commonly, whistleblowers are current or former employees of the defendant; however, the False Claims Act is not limited to the employment relationship. In some False Claims Act cases – like today’s – the Department of Justice may opt to commence a lawsuit on its own following an investigation into the fraud.

Continue reading…

Northwestern University Researcher Settles Grant Fraud Allegations

Northwestern University grant fraud

A former Northwestern University oncology researcher has agreed to repay $475,000 allegedly taken due to grant fraud.
Image source: Wikimedia Commons

Every year, the federal government puts billions of dollars toward medical research in the form of grants. Many of these grants are awarded to medical schools and research universities in order to advance efforts toward finding better treatments or possible cures for conditions like cancer, HIV/AIDS, heart disease, and various neurological disorders. These grants come with a lengthy contract agreement between the recipient and the government laying out the terms and conditions under which the recipient may use the money. At the crux of these agreements is the promise by the recipient to only use the grant money to further the stated research objective, and expenses must be carefully documented and submitted to the government on a regular basis.

Continue reading…