Info & Intel


Improper or Inadequate Staffing is Medicare Fraud

Did you know that Medicare publishes ratings of nursing homes? They are free and available online. You can see a numerical rating of the facility as well as key data on recent inspections, staffing and health and safety issues. Some states also publish inspections data.
 
Medicare publishes these nursing home ratings in the hopes that families will do comparison shopping before selecting a long term care facility.
 
In this post we will highlight one particular...

How to Report Medicare & Medicaid Fraud (and Collect a Reward)

Hint: Calling the Medicare Fraud Hotline Won’t Get You a Reward Google “How to Report Medicare Fraud” and in most states you will see the Medicare website at the top of the list. Medicare.gov recommends you report Medicare fraud by:  
Call us at 1-800-MEDICARE (1-800-633-4227) Report it online to the Office of the Inspector General. Call the Office of the Inspector General at 1‑800‑HHS‑TIPS (1‑800‑447‑8477). Do a similar search for How to Report...

Acadia Healthcare Will Pay $17 Million Medicaid Fraud Settlement, Largest Ever in West Virginia.

Acadia Healthcare Will Pay $17 Million Medicaid Fraud Settlement, Largest Ever in West Virginia.

Acadia Healthcare Company has agreed to pay $17 million to resolve allegations that it defrauded Medicaid out of $8.5 million. This is the largest settlement ever reached in a case of Medicaid fraud in West Virginia.
U.S. Attorney Mike Stuart emphasized the significance of an $8.5-million fraud for West Virginia’s Medicaid beneficiaries. “Medicaid fraud is not a victimless crime,” he said. “I am proud of the work of my office and that of our partners to ensure the...

Alabama Pharmacy Owners and Employees Indicted in $200 Million Medicaid Fraud Involving Medically Unnecessary Prescriptions

Alabama Pharmacy Owners and Employees Indicted in $200 Million Medicaid Fraud Involving Medically Unnecessary Prescriptions

A nurse, the owners, and several employees of Alabama-based Northside Pharmacy have been charged in a $200-million prescription drug fraud case. A DOJ investigation into the alleged scheme has resulted in a 103-count indictment. The pharmacy is located in Haleyville and operates as Global Compounding Pharmacy. The company has described itself as “one of the top three largest compounding pharmacies in the United States.”  
In one of the most egregious instances of...

Drugmaker Mallinckrodt Defrauded Medicare Out of Hundreds of Millions of Dollars, According to Whistleblower Suit

Drugmaker Mallinckrodt Defrauded Medicare Out of Hundreds of Millions of Dollars, According to Whistleblower Suit

The government has decided to intervene in a whistleblower lawsuit against Questcor Pharmaceuticals, the maker of H.P. Acthar. According to the allegations, the company used an elaborate scheme to boost sales revenue from the drug, defrauding taxpayers out of hundreds of millions of dollars.  
The alleged wrongdoing involved artificially inflating the price of the drug and offering kickbacks to physicians and other healthcare professionals to increase the number of Acthar...

Two Massachusetts HomeCare Providers Will Pay Over $10 Million Over MassHealth Fraud Allegations

Two Massachusetts HomeCare Providers Will Pay Over $10 Million Over MassHealth Fraud Allegations

Avenue Homecare Services and Amigos Homecare will pay a total of $10.4 million to resolve allegations that they defrauded Massachusetts’ Medicaid program MassHealth.  
Dracut-based Avenue Homecare and Lawrence-based Amigos Homecare, two home health providers, are separate entities, and Attorney General Maura Healy is investigating them as such, though they allegedly incurred similar misconduct.  
As the settlement was announced, Healy wrote in a statement that,...

US WorldMeds Will Pay $17.5 Million to Settle Medicare Fraud Claim Related to Kickbacks

US WorldMeds Will Pay $17.5 Million to Settle Medicare Fraud Claim Related to Kickbacks

US WorldMeds LLC has agreed to pay $17.5 million to resolve allegations that it violated both the Anti-Kickback Statute and the False Claims Act. The pharmaceutical company, based in Louisville, Kentucky, allegedly paid kickbacks to various entities to induce prescriptions of its Parkinson’s drugs Apokyn and Myobloc.
The Anti-Kickback Statute establishes that it is illegal for pharmaceutical companies to offer kickbacks to doctors in exchange for increasing the number of...

Hospital Chain CEO Will Pay $3.46 Million to Resolve Fraud Allegations Involving Kickbacks and Fraudulent Billings

Hospital Chain CEO Will Pay $3.46 Million to Resolve Fraud Allegations Involving Kickbacks and Fraudulent Billings

The CEO of Health Management Associates LLC, a hospital chain, will pay $3.46 million to resolve allegations that he caused the company to unnecessarily admit patients in order to increase billings to government healthcare programs.
Gary D. Newsome was CEO of the Florida-based healthcare provider between September 2008 and July 2013. After the fraud allegations surfaced, Health Management Associates was acquired by Community Health Systems Inc.
Prosecutors claim Newsome indirectly...

Astellas Pharma and Amgen Will Pay $125 Million to Resolve Kickback Allegations Involving Medicare Copays

Astellas Pharma and Amgen Will Pay $125 Million to Resolve Kickback Allegations Involving Medicare Copays

Astellas Pharma US and Amgen Inc. have just agreed to pay nearly $125 million to resolve allegations that they implemented a fraudulent scheme using foundations to illegally pay Medicare copays for drugs they themselves commercialized.
Medicare beneficiaries are sometimes required to copay for drugs prescribed to them and covered under the healthcare program. Among other reasons, copays were created by the government to help keep drug prices in check.
Under the Anti-Kickback...

Sutter Health and Affiliates Agreed to Pay $30 Million to Resolve Allegations of Medicare Advantage Fraud

Sutter Health and Affiliates Agreed to Pay $30 Million to Resolve Allegations of Medicare Advantage Fraud

California-based Sutter Health LLC and four of its affiliates will pay $30 million to resolve allegations of Medicare fraud related to the Medicare Advantage program. The Medicare Advantage providers allegedly misrepresented the health status of the plan’s beneficiaries in order to increase billings.  
Medicare Advantage is a system that provides per-person healthcare benefits to enrolled individuals based on certain risk parameters. By portraying beneficiaries to have higher...

Medicaid Fraud Hotline: 888.742.7248 or Report Online
and claim reward