- Health insurance giant Amerigroup has settled with the governments of the United States and the State of Illinois, agreeing to pay $225 million plus legal fees. Amerigroup was exposed by whistleblower Cleveland Tyson, who was the company's Government Relations executive. He brought the suit in 2002, which went to trial, where, according to a press release issued by his attorneys:
"...the jury found that Amerigroup deliberately avoided enrolling recipients with costly health conditions or who were pregnant and in their third trimester. These actions were taken while Amerigroup received IDPA payments calculated on Amerigroup providing healthcare to all enrollees."
- CoxHealth, a large non-profit hospital chain in the Springfield, MO area, has announced a $60 million FCA settlement stemming from allegations of "improper Medicare billing and questionable business relationships."
The False Claims Act Corrections Act will help undo some of the damage that has been done to the FCA in recent years by poor judiciary decisions, such as Allison Engine v. US.
I will post the full text of the approved language as soon as it becomes available.
The Justice Department told the Post there is a backlog of approximately 900 False Claims Act cases, and that the backlog could take years to unclog. Obviously the time involved can damage the ability to pursue even the most meritorious cases. Justice also told the Post that they reject about 75% of all filed FCA cases, and most of those have little merit. I would bet that quite a few of the cases rejected have some merit but why quibble over that? If there are 900 cases in the system and a quarter represent cases that should be pursued, that means there are 225 good cases of fraud stuck in a black hole. Continue Reading...