Medicaid or Medicare Fraud

A settlement has been reached in a whistleblower class action lawsuit brought against CRC Health Corp who is accused of submitting false claims by providing substandard treatment to adult and adolescent Medicaid patients suffering from alcohol and drug addiction at its facility in Burns, TN called New Life Lodge.

The whistleblower will receive a $1.5 million share of the settlement proceeds.

Filed in 2011, the lawsuit alleged that between 2006 and 2012, New Life Lodge billed the Tennessee Medicaid program (TennCare) for substance abuse therapy services that were not provided or were provided by therapists who were not properly licensed by the state of Tennessee.  The lawsuit also alleged that New Life Lodge failed to make a licensed psychiatrist available to patients at the facility, as required by the state’s regulations; failed to maintain patient-staffing ratios required by Tennessee Department of Mental Health regulations and billed for Medicaid patients in excess of the state-licensed bed capacity at the facility.  In addition to those accusations, the case claims that New Life Lodge double-billed Medicaid for prescription substance abuse medications given to residents at the facility.

A settlement has been reached in a whistleblower class action lawsuit brought against All Children's Health System Inc who is accused of submitting claims to Medicaid that were illegal under the Stark Law. 

The federal government will receive $4 million and the State of Florida will receive $3 million from the settlement. The whistleblower will receive a $1.9 million share of the state and federal settlement amounts.

Filed in July of 2011, the whistleblower case alleged that All Children's Health System Inc paid inflated salaries and bonuses to doctors to ensure that referrals and extra procedures stayed at All Children’s Hospital and that, as a result, their submissions for Medicaid reimbursement were fraudulent in violation of the False Claims Act.

A settlement has been reached in a whistleblower class action lawsuit brought against Baptist Health System Inc who is accused of submitting claims to federal health care programs for medically unnecessary services and drugs.

The whistleblower will receive a $424,155 share of federal settlement.

This settlement resolves allegations that, from September 2009 to October 2011, two neurologists in the Baptist Health network misdiagnosed patients with various neurological disorders, such as multiple sclerosis, which caused Baptist Health to bill for medically unnecessary services. 

A settlement has been reached in a whistleblower class action lawsuit brought against Children's National Medical Center who is accused of submitting false cost reports and other applications to the components and contractors of the Department of Health and Human Services (HHS), as well as to Virginia and District of Columbia Medicaid programs.

The whistleblower will recieve a share of the settlement, totalling $1,890,649.48 for his role.

Filed in 2014, the lawsuit claims that CNMC misreported its available bed count on its application to the HHS' Health Resources and Services Administration under the the Children's Hospital Graduate Medical Education (CHGME) Payment Program. The payment program gives federal funds to freestanding children's hospitals in order to help with their graduate medical education programs that train pediatric and other residents. The United States also contended that the CNMC made cost reports misstating their overheard costs, which then resulted in overpayment from Medicare and the Virginia and District of Columbia Medicaid programs.

A settlement has been reached in a whistleblower class action lawsuit brought against Infirmary Health System Inc (IHS), two IHS-affiliated clinics and Diagnostic Physicians Group P.C. (DPG) who are accused of paying or receiving financial inducements in connection with claims to the Medicare program.

The whistleblower will receive a $4.41 million share of the $24.5 settlement that was announced July 21, 2014.

The complaint, which was filed in July of 2011, alleged that in 1988, IMC purchased IMC-Diagnostic and Medical Clinic from DPG and agreed to pay DPG a share of the revenues the clinics collected, including Medicare revenues from diagnostic imaging and laboratory tests. After IMC acquired the IMC-Northside Clinic in 2008, the physicians practicing there joined DPG and entered into an agreement with the same key terms as the earlier agreement with IMC-Diagnostic and Medical Clinic. The government contended that these payments were illegal kickbacks and constituted a prohibited financial relationship under the Stark Law, and that in June 2010, an attorney for DPG warned employees of both IMC and DPG that the compensation being paid to the physicians likely violated the law. Nevertheless, the agreements allegedly were neither modified nor terminated for another 18 months.

A settlement has been reached in a whistleblower class action lawsuit brought against  Community Health Systems Inc (CHS) who is accused of knowingly billing government health care programs for inpatient services that should have been billed as outpatient or observation services. 

The settlement resolves lawsuits filed by several whistleblowers and their share amounts of the settlement have not been determined.

The originally filed whistleblower complaint was filed in January of 2009. Over time additional whistleblower complaints were filed and consolidated.  The complaints alleged that from 2005 through 2010, CHS increased inpatient admissions of Medicare, Medicaid and the Department of Defense’s (DOD) TRICARE program beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals. Additionally the complaints alleged that the inpatient admission of these beneficiaries was not medically necessary, and that the care needed by, and provided to, these beneficiaries should have been provided in a less costly outpatient or observation setting. A settlement of $89.15 was agreed upon to resolve these particular allegations.

An additional settlement amount of $9 million was agreed upon to resolve the allegations that from 2005 through 2010, one of CHS’s affiliated hospitals, LMC in Laredo, Texas, presented false claims to the Medicare program for certain cardiac and hemodialysis procedures performed on a higher cost inpatient basis that should have been performed on a lower cost outpatient basis. The government also alleged that from 2007 through 2012, LMC improperly billed Medicare for services referred to LMC by a physician who was offered a medical directorship at LMC, in violation of the Stark Law.

A settlement has been reached in a whistleblower class action lawsuit brought against Carondelet Health Network who is accused of submitting false bills to Medicare and other federal health care programs.

Carondelet Health Network has agreed to pay $35 million to resolve these claims.  The whistleblowerwill receive a share of the settlement of nearly $6 million.

The case was originally filed in November of 2011 and alleges that from April 7, 2004, through Dec. 31, 2011, two of Carondelet's hospitals, St. Mary’s Hospital and St. Joseph’s Hospital, billed Medicare, the Federal Employees Health Benefit Program, and the Arizona Health Care Cost Containment System (Arizona’s Medicaid agency) for inpatient rehabilitation facility services that were not properly reimbursable under applicable coverage criteria because the patients were not appropriate for inpatient rehabilitation facility services.  The government alleged that due to these false claims, federal health care programs paid far more than was necessary.

A settlement has been reached in a whistleblower class action lawsuit brought against Shire Pharmaceuticals LLC who is accused of engaging in unlawful drug marketing and promotion practices of several drugs.

The $56.5 million settlement is broken down as follows; the federal government will receive $35,713,965, and state Medicaid programs will receive $20,786,034.  The originally filing whistleblower will receive a $5.9 million share of the government settlement.

Originally filed in 2008, the complaint made claims of the following allegations;

(1) that between January 2004 and December 2007, Shire promoted Adderall XR for certain uses without clinical data to support such claims and overstated the efficacy of Adderall XR, particularly relative to other ADHD drugs,

(2) that between February 2007 and September 2010, Shire sales representatives and other agents allegedly made false and misleading statements about the efficacy and “abuseability” of Vyvanse to state Medicaid formulary committees and to individual physicians,

(3) that from April 2006 to September 2010, Shire representatives improperly marketed the patch administered medication Daytrana, as less abuseable than traditional, pill-based medications, and, for part of this period, improperly made phone calls and drafted letters to state Medicaid authorities to assist physicians with the prior authorization process for prescriptions to induce these physicians to prescribe Daytrana and Vyvanse, and

(4) that between January 2006 and June 2010, Shire sales representatives promoted Lialda and Pentasa for off-label uses not approved by the FDA and not covered by federal healthcare programs.  Specifically, the government alleged that Shire promoted Lialda off-label for the prevention of colorectal cancer.

A settlement has been reached in a whistleblower class action lawsuit brought against CareAll Management LLC who is accused of submitting false and upcoded home healthcare billings to Medicare and Medicaid programs.

CareAll agreed to a $25 million settlement, in which the originally filing whistleblower will receive $3.9 million.

Filed in 2012, the lawsuit alleged that between 2006 and 2013, CareAll overstated the severity of patients’ conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound. 

A settlement has been reached in a whistleblower class action lawsuit brought against Dignity Health (formerly Catholic Healthcare West) who is accused of submitting false claims and overbilling to Medicare and TRICARE (a mility healthcare program).

The whistleblower that filed the orignal lawsuit will receive approximately $6.25 million, whereas the entire settlement amount that Dignity Health agreed to pay is $37 million.

Filed in 2009, the  complaint alleged that from 2006 through 2010, 13 Dignity hospitals billed Medicare and TRICARE for inpatient care for certain patients who underwent elective cardiovascular procedures in scheduled surgeries when the claims should have been billed as outpatient surgeries.  Additionally allegations included that from 2000 through 2008, four of the Dignity hospitals billed Medicare for beneficiaries undergoing elective kyphoplasty procedures, which are minimally-invasive and performed to treat certain spinal compression fractures that should have been billed as less costly outpatient procedures.  The complaint also alleged that from 2006 through 2010, 13 hospitals admitted patients for certain common medical diagnoses where admission as an inpatient was medically unnecessary and appropriate care could have been provided in a less costly outpatient or observation setting.