US v Florida People
Ten people were indicted for allegedly committing fraud on private and public insurers for billing for rural hospital lab tests actually done by private labs and not the hospitals. This boosts the insurance payments to th hospitals that are owned by the indicted people. The indictment also says the tests were not medically necessary and that kickbacks sere paid.
US v Glenmark Pharmaceuticals
The company has been charged with fixing prices for generics along with Apotex Corp and others. Apotex has already paid $24 million to settle the charges.
California v Rosen
Dr. Randy Rosen a Beverly Hills surgeon and his girl friend Liza Vasamanos were charged with health care fraud. They allegedly paid brokers in sober living homes to undergo unnecessary surgery of Naltrexones implants. He was also charged of wending patients for un needed drug tests at his girl friend's Lotus Laboratories.
US v UPMC
UPMC has been accused of billing for procedures where no proper consent was obtained. The whistleblower suit alleges the surgeons designated others to obtain consent which is not kosher.
Little Sisters of the Poor v Pennsylvania
In an interesting twist the court used OCare language to determine that all employers no matter the size were not obligated to provide contraceptive services in their health care plans if they have moral or religious objections.
US v Oklahoma Center for Othopaedic and Multi-Specialty
The outpatient specialty hospital and its physician owners agreed to pay $72 million to settle allegations that they billed where there were improper relationships between the two. It is alleged that illegal kickbacks were paid by lower than market rate rentals, employees in exchange for patient referrals. This is is a qui tam suit.
US v Agendia
The molecular diagnostics firm agreed to pay $8.25 million to settle allegations that they conspired with hospitals to artificially delay ordering the test for breast cancer in order to get paid. It is illegal for some reason to order the test within 14 days of the hospitalization.
Ruckh v Salus Rehabilitation
In the whistleblower suit, the former RN at two of the Salas hospitals sued for fraudulent Medicare and Medicaid claims. A jury found for the nurse for $348 million. The appeal reduced that to about $255 million as it took out the Medicaid damages. She accused them of upcoding to inflate reimbursement. The lower court had set aside the jury verdict.
US v Henderson
Davon Henderson, the manager of Med-1 Interfacility Care ambulance company in Greenville, North Carolina, was sentenced to 64 months in prison for billing for fictitious ambulance services.
US v Dixon
Ray Dixon,R. Ph. of Baxley, Georgia, was sentenced to four years in prison for distributing opiates without a legitimate prescription.
US v Ophthalmic Consultants
The Tampa group agreed to pay $4.8 million to settle allegations that they multi dosed meds for wet macular degeneration and falsified the billing.
US v Shibley
Dr. Eric Shibley of Seattle, Washington, was arrested for fraud for applying illegally for PP loans using false information. He wanted $3 million in the PPP loans.
US v Shoemaker
Clifford Shoemaker and Kimberly Conner of Guam and Saipan respectively were sentenced for illegally charging for ambulance services for dialysis patients who did not need the services. They got 71 months and 63 months respectively and were ordered to pay almost $11 million is restitution and to forfeit the sesame amount.
US v Agendia
The California genetic testing company agreed to pay $8.25 million to settle allegations thar they conspired with hospitals to illegally delay ordering MammaPrint Assay to get around the 14 day rule. Lourdes Hospital in Kentucky had settled earlier and their employees had bought the qui tam suit.
US v Advanced Cardiovascular Care Center
The Houston medical practice and its owner Dr. Annie Varughese along with he administrator Babu Varughese agreed to pay $400,000 to settle allegations that billed for cardiology tests not need nor necessary.
US v Novaritis
The company agreed to pay $642 million to settle allegations that they set up false companies to pay for the copays of Medicare patients taking their drugs. they also settled an allegation that they paid kickbacks to physicians in their speaker program really to prescribe their meds.
US v Medscan
The Puerto Rico company and its owner Dr. William Cruz agreed to pay $1 million to settle allegations that they billed falsely when Cruz' Medicare billing had been revoked.
US v Hope Hospice
The Florida hospice agreed to pay $3.2 million to settle allegations that they knowlingly submitted false claims wo did not qualify for their services.
US v Davis
John Davis of Franklin, Tennessee, was sentenced to 42 months in prison. He was the former CEO of Comprehensive Pain Management Specialists and received kickbacks for DME. He had to forfeit the money $770,000 as well.
US v United Health Services
The psychiatric organizations agreed to pay $122 million to settle allegations that they submitted false claims for behavioral health services that were not necessary or needed. This settled many qui tam cases. Top
Moda Health v US
The government, following the Supreme court decision in Maine community v US, agreed to pay Moda Health $249 million for its risk sharing portion. Top
California v Lakeview Terrace
The nursing home in LA has been accused of illegal patient dumping long term residents in order to get well insured Covid patients . The home is a low raked placed and has paid fines in the past for patient dumping. Top
Brewer v Fruedenberger
The state high court ruled that med mal defense attorneys could conduct ex parte interviews with the plaintiffs physicians without any restrictions. The lower court took HIPAA out of context and put restrictions on the interview.
McAlpine v Norman
Plaintiff sued defendant physician Norman. Norman's expert said that "at all times" Dr. Norman met the standard of care. The trial judger then granted the motion to dismiss. The appeals court said "wait a minute". The statement without any back up is not enough. Case back on. The plaintiff's attorney then screwed up and was caught. He attempted to add the surgeon that lacerated the plaintiffs liver and also a charge that the physician Norman delegated illegally the consent process. The court said you didn't have these before and you can not add them now. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.