17 results for 'cat:"Medicare" AND cat:"False Claims"'.
J. Readler finds the lower court properly dismissed the False Claims Act lawsuit for a lack of evidence. The employees' complaint did not include specific examples of supposed fraud on the part of the insurer or instances where claims adjusters knew they were defrauding the Medicare program through a refusal to declare itself a "primary payer" on an insurance claim.
Court: 6th Circuit, Judge: Readler, Filed On: June 27, 2024, Case #: 23-1196, Categories: Insurance, medicare, false Claims
J. Bumb allows Allstate Insurance to continue claims contending a lab company submitted duplicative and medically unnecessary urine drug testing claims to Medicare and Medicaid. The insurer, as relator, sufficiently alleged the lab company encouraged physicians to order screening tests as a matter of course and without regard to need.
Court: USDC New Jersey, Judge: Bumb , Filed On: May 30, 2024, Case #: 1:22cv6303, NOS: Qui Tam (31 U.S.C. § 3729(a)) - Torts - Personal Property, Categories: Medicaid, medicare, 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