medical-stethoscope-blue-pen-paper-medicare-fraudIn a recent interview with the AARP, Attorney General Sessions took a strong stance against Medicare fraud and empowering Medicare whistleblowers. Sessions stated that it’s time to consider taking Medicare fraud as seriously as the war on drugs (certainly an issue Attorney General Sessions believes to be of paramount importance).

Medicare fraud is a serious issue. It is estimated that 10% of Medicare funds are lost to fraud and waste, totaling approximately $16.2 billion. This suggests that billions of dollars, which should be directed to funding health care for our seniors, are instead going to fraudsters taking advantage of American taxpayers and the elderly.

Continue Reading Whistleblowers Vital to Eliminating Medicare Fraud

The Department of Justice recently announced the settlements, listed below, in False Claims Act cases. The False Claims Act permits private parties to sue on behalf of the government those who falsely claim federal funds or avoid paying funds owed to the government.  The United States may intervene in and take over the lawsuit.  The False Claims Act also allows the whistleblower to receive a share of any funds recovered through the lawsuit. The False Claims Act is one of the most powerful tools to combat government contract fraud.  Continue Reading FCA Settlements Bring In Millions From Medicare Fraud

The Department of Justice announced today that Medical device manufacturer ev3 Inc., formerly known as Fox Hollow Technologies Inc., has agreed to pay the United States $1.25 million to resolve allegations under the False Claims Act that Fox Hollow caused certain hospitals to submit false claims to Medicare for unnecessary inpatient admissions related to minimally-invasive atherectomy procedures.  Continue Reading U.S. Settles FCA Case Against Medical Device Manufacturer for $1.25 Million

Yesterday, the Justice Department announced that Community Health Systems, Inc., the nation’s largest operator of acute care hospitals, has agreed to pay $98.15 to settle multiple lawsuits against it filed under the False Claims Act. Nine whistleblowers stepped forward to report “a deliberate corporate-driven scheme” to bilk the U.S. taxpayers of millions of dollars.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $20.2 billion through False Claims Act cases, with more than $14 billion of that amount recovered in cases involving fraud against federal health care programs.

For more information on this settlement see the DOJ Press Release.

C.R. Bard Inc., a medical device company based in New Jersey, has agreed to pay the United States $48.26 million to resolve claims that it knowingly caused false claims to be submitted to the Medicare. The claim alleged that the company paid off doctors and hospitals to induce them to prescribe brachytherapy seeds. Giving such kickbacks is a violation of the False Claims Act.

The settlement requires that Bard pay $48.26 million and it resolves claims relating to Bard’s sale of brachytherapy seeds, a form of radiation therapy, to hospitals. The United States alleged that from 1998 to 2006, Bard provided illegal remuneration to customers and physicians to induce them to purchase Bard’s seeds, in violation of the Anti-Kickback Statute.   The illegal remuneration allegedly took the form of certain grants, guaranteed minimum rebates, conference fees, marketing assistance and/or free medical equipment that Bard paid to customers and/or physicians who used the seeds to perform treatment for prostate cancer.   Hospitals ultimately submitted bills to Medicare for these seeds, which the government alleged were rendered false by Bard’s illegal kickback activity. The government alleged that Bard was liable under the False Claims Act for causing the submission of those false claims. 

Continue Reading Bard Whistleblower Awarded $10.1 Million

On April 24, 2013, Health and Human Services Secretary Kathleen Sebelius announced a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million.

Over the last three years, the HHS has recovered over $14.9 billion in fraud, some of which resulted from fraud reporting by individuals – a proven tool in helping the government detect fraud, waste and abuse in the Medicare program. 

The proposed rule would increase the potential reward amount for individuals who report information that leads to a recovery of Medicare funds from 10 percent to 15 percent of the final amount collected. The current program caps the reward at $1,000, meaning HHS pays a reward on the first $10,000 it collects as a result of a tip. HHS is also proposing to increase the portion of the recovery on which HHS will pay a reward up to the first $66 million recovered – this means an individual could receive a reward of $9.9 million if HHS recovers $66 million or more. 

Continue Reading Proposed Rule Would Increase Rewards to Medicare Fraud Whistleblowers to Nearly $10 Million