24 results for 'cat:"Medicare" AND cat:"False Claims"'.
[Consolidated.] J. Scudder finds that the lower court properly found the businessman and three associated healthcare companies violated the Anti-Kickback Statute and False Claims Act by knowingly paying kickbacks to induce referrals for medical services, many of which were paid for by Medicare. However, the $6 million judgment against the businessman must be revised, because the lower court did not sufficiently clarify which Medicare claims - all or some - resulted from the illegal kickback scheme. Affirmed in part.
Court: 7th Circuit, Judge: Scudder, Filed On: May 2, 2024, Case #: 22-3295, Categories: Damages, medicare, false Claims
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[Consolidated.] J. Gilson finds that the trial court properly dismissed claims contending pharmaceutical companies used free nurse and reimbursement support services to market drugs in order to submit inflated Medicare and Medicaid claims because the health centers lacked standing to act as relators, and the claims are nearly identical to similar federal complaints filed in Texas. Affirmed.
Court: New Jersey Appellate Division, Judge: Gilson , Filed On: March 1, 2024, Case #: A-2731-20, Categories: Medicaid, medicare, false Claims
J. Seeger grants a nursing home operator’s motion to dismiss whistleblowing claims brought by an Illinois pharmacy owner, who said the nursing home operator provided patients with medication without prescriptions so it could cash in on Medicare payments. The court finds the government and pharmacy owner have not sufficiently alleged their claim under the False Claim Act, and concludes that their claim under the Controlled Substances Act is not actionable.
Court: USDC Northern District of Illinois, Judge: Seeger, Filed On: February 28, 2024, Case #: 1:20cv1169, NOS: Other Statutory Actions - Other Suits, Categories: medicare, Elder Abuse, false Claims
J. Pallmeyer denies a doctor’s motion to vacate a jury finding that he is liable for 158 false Medicare claims. The court finds that given the evidence which emerged at trial, and a similar finding against the doctor’s wife, the jury made a fair ruling in his case.
Court: USDC Northern District of Illinois, Judge: Pallmeyer, Filed On: February 15, 2024, Case #: 1:17cv4011, NOS: Other Statutory Actions - Other Suits, Categories: Jury, medicare, false Claims
J. Ozerden partly grants a medical center administrator's motion to dismiss claims filed by relators for allegedly submitting false Medicare reports. Some of the claims exceed the statute of limitations, specifically claims based on reports submitted before October 18, 2012.
Court: USDC Southern District of Mississippi , Judge: Ozerden, Filed On: December 21, 2023, Case #: 1:16cv38, NOS: Qui Tam (31 U.S.C. § 3729(a)) - Torts - Personal Property, Categories: Fraud, medicare, false Claims
J. Saylor certifies for interlocutory appeal the court’s conclusion that, if a Medicare reimbursement claim includes items or services stemming from an Anti-Kickback Statute violation, the claim must also be shown to constitute a false claim under the False Claims Act. Two different judges reached different conclusions on that issue in separate cases.
Court: USDC Massachusetts, Judge: Saylor, Filed On: October 25, 2023, Case #: 1:20cv11217, NOS: False Claims Act - Torts - Personal Injury, Categories: Fraud, medicare, false Claims
J. Sullivan finds that the district court should have dismissed a false claims action contending federal and state parties failed to intervene when Medicare and Medicaid reimbursements were applied to expenses incurred by a medical center instead of being provided to a nursing home because the so-called benefits conversion statute does not require that the money be used in a particular way. Reversed.
Court: 2nd Circuit, Judge: Sullivan, Filed On: October 16, 2023, Case #: 21-1534, Categories: Medicaid, medicare, false Claims
J. Gershon dismisses a False Claims Act whistleblower complaint brought against an oncology clinic for allegedly charging Medicare for overfill oncology medications. The litigant, a healthcare provider, fails to allege its principal had firsthand knowledge of the defendant’s actions or conducted a thorough investigation to corroborate claims made by other sources. As well, it fails to show that the defendant voluntarily disclosed relevant information to the U.S. government, a requirement under the law.
Court: USDC Eastern District of New York, Judge: Gershon, Filed On: September 8, 2023, Case #: 1:19cv5125, NOS: False Claims Act - Torts - Personal Injury, Categories: Health Care, medicare, false Claims
J. Seeger grants a rehab clinic’s motion to dismiss fraud claims brought by two of its former executive employees, which allege that the clinic provided patients with unnecessary therapy in order to milk them for Medicare payouts. The court finds the former employees have not provided sufficient evidence to substantiate their claims, but grants them two weeks to amend their complaint.
Court: USDC Northern District of Illinois, Judge: Seeger, Filed On: September 8, 2023, Case #: 1:18cv6063, NOS: False Claims Act - Torts - Personal Injury, Categories: Fraud, medicare, false Claims
J. Lawson denies the home health care and hospice company's motion to dismiss an action brought by the relator under the False Claims Act and Anti-Kickback statute. The relator claims the company, which operates more than 300 home health care agencies across the nation, admitted ineligible patients for care and billed Medicare for excessive or medically unnecessary services. The relator also alleges the company compensated a doctor for falsifying patient certification forms and fired her for voicing concerns. The relator alleged sufficient facts to support the claims that the company and its subsidiary submitted false claims for payment.
Court: USDC Middle District of Georgia, Judge: Lawson, Filed On: August 23, 2023, Case #: 7:21cv17, NOS: Qui Tam (31 U.S.C. § 3729(a)) - Torts - Personal Property, Categories: medicare, false Claims
[Consolidated.] J. Wilson finds the trial court properly ruled in favor of the government on this False Claims Act suit involving the management firm’s overbilling for Medicare reimbursements over a 12-year period. Though the government’s continuing requests for extensions resulted in eight years of delays, this is not cause to dismiss. Case law cited by the management firm does not support its argument for dismissal. Though, because the government fails to invoke tolling according to the FCA, the act’s statute of limitations bars its claims from accruing six years prior to filing its first intervenor complaint. Damages must be remitted accordingly. Affirmed in part. Reversed in part and remanded. The consolidated appeal is dismissed.
Court: 5th Circuit, Judge: Wilson, Filed On: August 21, 2023, Case #: 21-60568, Categories: Government, medicare, false Claims
J. Teeter rules the government may pursue Medicare fraud claims against a physician and his wife, who is also a physician. The government sufficiently showed in court that the couple knew they were falsely submitting 1,383 Place of Service codes.
Court: USDC Kansas, Judge: Teeter, Filed On: August 18, 2023, Case #: 2:17cv2395, NOS: False Claims Act - Torts - Personal Injury, Categories: Fraud, medicare, false Claims
J. Gorton denies a pharmaceutical company’s motion for summary judgment and grants the federal government’s motion for partial summary judgment in a case against the pharmaceutical firm for allegedly paying kickbacks for false Medicare claims through illegal copay subsidies on Copaxone, a drug for multiple sclerosis. There are emails from the drug maker’s employees that show its employees believe that the company would have lost Copaxone sales if it didn’t offer the subsidies. Anti-kickback statute violations that result in federal health care payments are automatically considered false claims under the False Claims Act.
Court: USDC Massachusetts, Judge: Gorton, Filed On: July 14, 2023, Case #: 1:20cv11548, NOS: False Claims Act - Torts - Personal Injury, Categories: Health Care, medicare, false Claims
J. Brinkema grants the government's motion for summary judgment in a False Claims Act suit. The medical company, accused of lying to Medicare to receive extra reimbursements, failed to file an answer nor request additional time to retain counsel.
Court: USDC Eastern District of Virginia, Judge: Brinkema, Filed On: May 26, 2023, Case #: 1:22cv965, NOS: False Claims Act - Torts - Personal Injury, Categories: Health Care, medicare, false Claims
J. Hollander denies a pharmacist his motion for partial summary judgment before discovery following the criminal prosecution of his former employer, a pharmacy owner, who submitted false claims to Medicare and TRICARE and a created a kickback scheme. However, because multiple documents remain sealed from the criminal trial, the pharmacist cannot prove himself as an original source of information, which the owner contests, so summary judgment cannot be awarded.
Court: USDC Maryland, Judge: Hollander, Filed On: May 24, 2023, Case #: 1:17cv2335, NOS: Qui Tam (31 U.S.C. § 3729(a)) - Torts - Personal Property, Categories: medicare, Discovery, false Claims