Soon after Wendy Horne began working at Pinnacle Medical Solutions, a Mississippi-based medical supply company, she noticed irregularities in the company’s handling of insurance reimbursement claims. When she suggested that the company repay money to which it wasn’t entitled, Horne says, she was ignored and eventually fired. Horne then reported her findings to the U.S….
Dallas-Area Trade Schools Named in FCA Suit
A qui tam lawsuit, unsealed last week after intervention by the DOJ, accuses the for-profit trade school ATI Enterprises of fabricating job-placement data and other statistics in an effort to preserve eligibility for state and federal funding. The complaint also accuses ATI of misleading prospective students by inflating the reported salaries of its graduates, creating…
$16.5 Million Settlement for Medicare Fraud Using Homeless Patients
A hospital chain in California has agreed to pay $16.5 million to resolve charges that it perpetrated a scheme to defraud Medicare of millions of dollars. The civil suit against Los Angeles Doctor’s Hospital Inc. alleges that the company hired “marketers” whose job was to recruit homeless individuals to undergo expensive and often unnecessary medical…
SEC Pays First Award Under Dodd Frank Whistleblower Program
The Securities and Exchange Commission has announced its first award under the whistleblower program created by the Dodd Frank Act. The whistleblower, who remains anonymous, will receive $50,000, or 30 percent of the amount collected thus far, as well as a portion of any additional funds subsequently collected. According to the SEC, the whistleblower’s information…
Feds Begin Rollout of High-Tech Fraud-Detection Systems
Among its other provisions, the Affordable Care Act gave federal authorities the authority and funding to employ sophisticated fraud-detection technology in the fight against phony Medicare billing. These powerful computer systems comb through millions of claims each day, seeking redundancies, inconsistencies, or other red flags in a process akin to those used by credit card…
Dental Fraud Draws Scrutiny in Texas
State officials in Texas are turning renewed attention to fraudulent billing for Medicaid-covered dental procedures, the Wall Street Journal reports today. Doctors across the state are alleged to have inflated their billing by, for example, performing unnecessary root canals and installing braces on children for purely cosmetic reasons. Such improper procedures are blamed for contributing…
Under Pressure from Capitol Hill, IRS Increases Pace of Awards
The IRS has paid out more than 90 whistleblower awards since October 2011, an increase from prior levels that some commentators have linked to pressure from an interested party in Congress. Senator Charles Grassley (R-Iowa), former chair of the Senate Finance Committee, recently held up the confirmations of two key IRS officials in protest of…
States to Collect $151 Million in McKesson Settlement
In April, pharmaceutical wholesaler McKesson Corp. agreed to pay the federal government more than $190 million to settle allegations that it reported inflated prices for a large number of its drugs in order to raise the “Average Wholesale Price” (AWP) benchmark and cause Medicare to overpay for the medicine. Now, the company has agreed to…
GSK Pays $3 Billion, Largest Health Care Fraud Settlement in US History
GlaxoSmithKline has agreed to pay $3 billion to resolve allegations that it illegally promoted drugs for off-label uses, failed to disclose risks associated with one of its drugs to the FDA, and engaged in fraudulent price reporting practices. This is the largest health care fraud settlement in U.S. history. Under the criminal plea agreement, GSK…
$4 Million Settlement for Natural Gas Fraud
Louis Dreyfus Energy Services, a Connecticut energy company, has paid $4 million to resolve allegations that over a period of more than three years it underpaid the federal government for natural gas extracted from federal lands. In 2004, Louis Dreyfus entered into an ongoing contract with the United States for natural gas that included a…