Cancer is difficult enough to endure, with many uncomfortable procedures, without you or a loved one having to worry about undergoing unnecessary ones. But that’s exactly what it is alleged that 21st Century Oncology Inc., headquartered in Florida and the US’s biggest physician-led integrated cancer care provider, did in many cases. Adding insult to injury, 21st Century Oncology billed $34.7 million for these medically-unnecessary procedures. Continue reading
Major Cancer Care Provider to Pay $34.7 Million False Claims Settlement
A sleep therapy products supplier, Respironics Inc., based in Pennsylvania, agreed to resolve charges of False Claims Act violations by paying $34.8 million because of a qui tam suit brought by a whistleblower. The agreement, announced in March 2016 by the U.S. Department of Justice, claims that kickbacks in the form of free call center services were paid by Respironics. These free services were supposedly given to durable medical equipment (DME) suppliers who bought sleep apnea masks from the Pennsylvania company during the period from April 2012 to November 2015. 
Environmental regulations are part of our lives, and rightly so. We need to keep from trashing our home, this planet, for ourselves and for future generations. A lot of time, effort, and money have gone into cleaning up old messes and preventing new ones, from the fossil fuels industry to nuclear plants. However, as always, the fraudsters are looking for opportunities. 
The Department of Justice (DOJ) has announced that, for all of fiscal year (FY) 2015, over $3.5 billion in settlements and judgments were obtained because of fraud cases against the government brought under the False Claims Act (FCA). This marks the fourth consecutive year that recoveries exceeded $3.5 billion. It was also the sixth consecutive year that over 700 new cases were brought under the FCA’s qui tam provisions, which allows whistleblowers (also known as relators) to bring false claims suits on behalf of the government and thereby share in any monetary recovery. 
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Educational loan abuse and fraud are starting to see their share of whistleblowers bringing cases under the False Claims Act (FCA). Student loans taken under dubious circumstances have become multi-million-dollar moneymakers at for-profit schools like ITT and the University of Phoenix.
Two whistleblowers—a cardiac nurse and a healthcare consultant—are sharing more than $3.5 million, which is their portion of a $23 million qui tam False Claims Act settlement. The case, which was resolved mid-February of 2016, involved 51 hospitals that allegedly disobeyed Medicare rules regarding coverage of implanting heart defibrillation devices.
On December 3, 2015, the District of South Carolina’s U.S. Attorney’s Office announced that it had collected over $7 million during fiscal year 2015 for U.S. taxpayers in various criminal and civil cases. In criminal actions, roughly $4.4 million was received, while for civil actions, the amount was almost $2.7 million. Most of the $7 million collected came from False Claims Act and whistleblower actions. 
Whistleblower cases involving the Veterans Administration (VA) took a significant upturn in fiscal year 2015, according to the Office of Special Counsel (OSC). Although it is small—with only 140 employees—and independent, the agency’s job is to protect whistleblowers and other federal employees from prohibited personnel actions. The OSC’s 2015 whistleblower disclosures rose 56 percent from 2014, for a total of 755 disclosures for the fiscal year. 
When you think of Medicare fraud, ambulance services might not come to mind. After all, in a life-threatening situation, you’re going to call 911 for an ambulance. You’re not going to think about kickbacks, unnecessary procedures, upcoding, and other deceitful practices happening in the ambulance industry. And yet, ambulance fraud is big business for some Medicare suppliers.