The United States alleged that the home health agency operator Bayada purchased two of Watermark’s properties in Arizona to induce referrals of Medicare beneficiaries. A former Bayada executive earned about $3.8M for blowing the whistle.
Based in Tucson, Watermark manages 79 senior retirement homes but the scheme was designed around...National News
Last Thursday, the U.S. Supreme Court ruled unanimously that supermarket chains Safeway and Supervalu defrauded the government by knowingly claiming fraudulent Medicare and Medicaid reimbursements.
The decision overturned a 7th Circuit Court of Appeals ruling that the defendants didn't "knowingly" violate the False Claims Act (FCA),...
The U.S. Supreme Court heard arguments last week on an issue regarding retail pharmacies overcharging government health plans that could compromise the False Claims Act.
The case dates from 2006, when Walmart offered unsustainably low drug prices to cash customers and charged Medicare and Medicaid plans far higher than the original...
On Tuesday, the U.S. Department of Justice filed a complaint in a lawsuit against the Arizona company Modern Vascular and its founder, chiropractor Yury Gampel.
Gampel and Modern Vascular's labs are accused of violating federal laws including Stark Law, the Anti-Kickback Statute and the False Claims Act by paying illegal kickbacks to...
The success of Medicare Advantage (MA) can't be understated. In the last 11 years, the program has grown to represent nearly 50% of the Medicare-eligible market, a benchmark it will likely pass within the next year.
Arizona MA growth reflects the program's national success. At the Hertel Report's 2020 Winter State of the State, Dan...
On Tuesday, the U.S. Department of Justice announced that it garnered more than $5.6 billion in judgements and settlements from False Claims Act cases, the largest since 2014. Over $5 billion of those claims are related directly to the healthcare industry.
From the DOJ press release:
Health care fraud was once again the leading...Arizona News
The $18.3 million settlement agreement released Friday by the Health and Human Services Office of Inspector General, calls for a long list of reforms that Banner must implement then maintain for five years.
Banner's present legal trouble stemmed from a whistleblower complaint filed under the False Claims Act in 2013 by Cecilia...Arizona News
Banner Health has agreed to pay the United States over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis.
The settlement resolves allegations that 12 Banner Health hospitals...National News
Justice Department claimed the insurer obtained more than $1 billion from Medicare based on inaccurate information. Judge disagreed. United counter sues.
Reuters is referenced in a Becker's Hospital Review report. The original False Claims Act lawsuit claimed UnitedHealth received at least $1 billion in Medicare reimbursement by...National News
The lawsuit claims the insurance provider submitted invalid data concerning the health status of patients enrolled in Medicare Advantage plans to the tune of more than $1 billion.
Medicare helps about 56 million people of which approximately 19 million have chosen to enroll in Medicare Advantage plans as an alternative to a standard...
The complaint alleges that Epic refused to adjust its billing software after the Centers for Medicare & Medicaid Services changed the way hospitals bill for anesthesia, prompting hospitals that use its software to improperly bill Medicare and Medicaid.
The whistleblower in the lawsuit, Geraldine Petrowski, worked as a compliance...