Info & Intel


Bonuses - Kickbacks for Slacker Dr. Referrals at Montana Hospital, Says KRH Whistleblower Lawsuit

Bonuses - Kickbacks for Slacker Dr. Referrals at Montana Hospital, Says KRH Whistleblower Lawsuit

Medical patients have a reasonable expectation that when a doctor makes a referral to a specialist, the doctor has their wellbeing in mind. But according to a complaint filed in U.S. District Court, patients at a Montana hospital weren’t always given that respect. Instead, doctors made referrals in consideration of their own financial gain.
Per the complaint, Kalispell Regional Healthcare (KRH), a healthcare system based in Kalispell, Montana, was engaging in illegal behavior and...

Upcoding and CAPITAL LETTERS – a New Way to Commit Billing Fraud

Healthcare fraud has reached epidemic levels in the United States. At times, the situation has become so bad that the Centers for Medicare and Medicaid Services (CMS) had to resort to drastic measures such as a moratorium on licensing new providers! That means the agency didn’t have the time to license new providers because all its resources were concentrated on rooting out bad providers.
In recent years we have seen these measures in Detroit, Houston and Philadelphia. When that...

Signature Settles $244M Fraud Whistleblower Lawsuit for Just $30M

Signature Settles $244M Fraud Whistleblower Lawsuit for Just $30M

Signature HealthCARE, one of the country’s largest healthcare facility operators, has agreed to pay $30 million to settle a False Claims Act lawsuit filed three years ago.
That seems like a hefty sum, until you realize the extent of the Medicaid fraud its staff allegedly committed—which amounts to $244 million, according to the U.S. Justice Department. 
Regardless, it’s a good thing that Signature is being held accountable for its supposed fraud, which...

Hospice Provider Accused of Admitting Non-Terminal Patients; Settles for $8.5M

Generally, nurses don’t want to see their patients take a turn for the worse. But Barbara Hinkle, a hospice care nurse, said she was repeatedly told by her supervisors at Caris Healthcare to “chart negatively”—basically, indicate a decline in health—even when patients’ conditions were stable.
Hinkle claimed she was directed to admit non-terminal patients and falsify or exaggerate medical charts throughout the 10 months she worked at the Bristol, VA...

Jeff Sessions Announces Massive Medicare Fraud Takedown in Connection with Opioid Crisis

Jeff Sessions Announces Massive Medicare Fraud Takedown in Connection with Opioid Crisis

The Attorney General just announced the largest healthcare fraud crackdown to date, which is targeting  600 people, including over 150 healthcare professionals. The cases are related to the opioid addiction epidemic.
According to the DOJ’s allegations, the defendants submitted false claims to the government in the amount of $2 billion in connection with opioid prescriptions and distribution. 
In the announcement, Sessions referred to the opioid epidemic, stating that...

Tennessee Medicaid Fraud Control Unit Gets an “A”

Tennessee Medicaid Fraud Control Unit Gets an “A”

Congress spent $376 billion on Medicaid last year. The states spent billions more. Unfortunately, approximately 10% of that money gets lost to fraud. Standing between taxpayers and corrupt hospitals, pharmaceutical companies and doctors are the state Medicaid Fraud Control Units. Every state has one including Tennessee.
Last year the federal Centers for Medicare and Medicaid Services audited the Tennessee Medicaid Fraud Control Unit. We are happy to report that Tennessee passed its review...

Health Diagnostics’ Former CEO and BlueWave Owners Will Pay $111 Million Over Medicare Fraud

Health Diagnostics’ Former CEO and BlueWave Owners Will Pay $111 Million Over Medicare Fraud

A federal judge in South Carolina has ordered the former CEO of Health Diagnostics Laboratory and the owners of BlueWave Healthcare Consultants Inc. to pay $111 million in connection with their alleged defrauding of Medicare and another government health care program.
Although the defendants presented arguments that the penalty would be in violation of the Eighth Amendment’s excessive fines clause, the judge decided to rule against Latonya Mallory, the former CEO of the testing lab,...

Arizona’s Banner Health Settles Fraud Lawsuit for $18M; Whistleblower Will Get $3M

Arizona’s Banner Health Settles Fraud Lawsuit for $18M; Whistleblower Will Get $3M

You would expect major health care companies to have the integrity (and massive revenues) to bill patients correctly and be honest about the reimbursements they’re entitled to.
But it’s not just small-town providers who try to get away with fraud: Banner Health, which manages 28 hospitals in two states, will have to pay $18 million to the U.S. government for submitting false claims to Medicare.
Thanks to a whistleblower, the company will be held accountable for scamming...

NC Health Care CEO Gets 8 Years in Prison for Medicaid Fraud and Perjury

NC Health Care CEO Gets 8 Years in Prison for Medicaid Fraud and Perjury

Another player in a massive scheme to defraud the North Carolina Medicaid Program has been sentenced to prison time. Shephard Lee Spruill, CEO of Carolina Support Services in Greenville, NC, was found guilty of health care fraud conspiracy and perjury and sentenced to eight years in prison.
The court also ordered him to pay back the nearly $6 million he helped steal from the taxpayer-funded health care system.
Spruill was one of many health care providers and administrators involved...

United Therapeutics to Pay $210 Million over Medicare Fraud Involving “Charitable” Donations in Exchange for Drug Co-Payments

United Therapeutics to Pay $210 Million over Medicare Fraud Involving “Charitable” Donations in Exchange for Drug Co-Payments

The Maryland-based pharmaceutical company United Therapeutics has agreed to pay $210 million to resolve allegations that it “used a foundation as a conduit to pay the copays of Medicare patients taking UT’s pulmonary arterial hypertension drugs, in violation of the False Claims Act,” according to a Department of Justice spokesperson.
The settlement comes amid a large scope DOJ investigation into a culture of pharmaceutical company donations to patient-assistance...

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