On May 2 a New Orleans federal jury found that Psalms 23 DME, LLC—its Biblical name notwithstanding--was part of a fraud scheme that illegally billed Medicare $3.2 million. In 2013 the government indicted Psalms 23 owner Tracy Brown and a colleague for a fraud scheme that involved billing Medicare for …
Aetna Wins $37.5 Million for Overbilling Scheme
April 18, 2016 Leave a Comment
It’s easy to fall into the habit of regarding self-referrals and kickbacks as strictly a matter of federal law, governed only by the federal Stark Law and Anti-Kickback Statute. But an April 13 verdict in California provides a vivid reminder that state law also has a role and that private insurers can be as …
Retaliation Claim Survives Though False Claim Act Claim Is False
March 28, 2016 Leave a Comment
Roxanne Perkins was employed as a clinical supervisor of prior authorizations therapy at Wellcare Health Plans. When she returned from a leave of absence, she learned that Wellcare had instituted a new practice of approving all preauthorization requests for durable medical equipment. She complained that the …
Masked Man Robs Government; Faces 10 Years
March 8, 2016 Leave a Comment
The mask itself didn’t raise any suspicions. After all, the man wearing it—Richard Toussaint--was an anesthesiologist. But like so many other masked men, he turned out to be a thief. That’s why on March 4 he was convicted in a Texas federal court on seven counts of health care fraud totaling about $10 …
Health Care Fraud and Abuse Enforcement Priorities in Minnesota
March 7, 2016 Leave a Comment
United States Attorney for the District of Minnesota, Andrew Luger, spoke at a public event on March 3, 2016, at Mitchell-Hamline School of Law on the topic of health care fraud & abuse enforcement priorities in Minnesota. Luger began the discussion explaining the resource shortage issue in the white collar …
Criminal Conviction Leaves Defendant Defenseless in FCA Civil Action
February 2, 2016 Leave a Comment
Pity Dr. Christina Clardy. In 2011 she was convicted of health care fraud, sentenced to 135 months in prison, and ordered to pay $16 million in restitution. Then in 2014 the government added Christina as a defendant in its pending False Claims Act (FCA) civil action against her cronies in the physical …