The federal government has been working to make pricey prescription drugs more affordable for the roughly 54.1 million people who are enrolled in the Medicare prescription program, known as Part D. However, fraud threatens to cost both the … [Read more...]
Report Says Medicare Part C Insurers Are Pocketing Billions Through Risk Adjustment Schemes
Medicare Advantage, or Part C, was created with the idea that private insurers could provide more cost-effective healthcare than traditional Medicare. But while the program has become popular — it’s the largest taxpayer-funded health insurance … [Read more...]
Sutter Health settlement part of record year for whistleblower recoveries
A record $90 million False Claims Act settlement for the government as a result of a whistleblower lawsuit by a Keller Grover client was among the cases highlighted by the U.S. Department of Justice in a recent announcement touting its 2021 … [Read more...]
Telemedicine fraud remains DOJ priority
As telemedicine fraud remains a top enforcement priority of the U.S. Department of Justice, whistleblowers can play a key role in helping the government recoup taxpayer dollars lost to fraud. In September 2021, the DOJ announced charges against … [Read more...]
Government watchdog flags risk-adjusted Medicare Advantage payments
In September, the U.S. Department of Health and Human Services’ Office of Inspector General issued a report raising concerns that some Medicare Advantage companies inappropriately used chart reviews and health risk assessments, or HRAs, to receive … [Read more...]
Biden DOJ to continue focus on health fraud
The U.S. Department of Justice’s Civil Division remains focused on prosecuting healthcare fraud despite a changing of the guard in Washington, a DOJ official told a group of lawyers in late June. In an address to the American Health Law … [Read more...]
Keller Grover, Constantine Cannon and Kleiman Rajaram Announce Record $90 Million False Claims Act Whistleblower Settlement with Sutter Health
Sutter Health settles closely watched whistleblower lawsuit alleging it violated the False Claims Act by submitting inaccurate and unsupported medical information on tens of thousands of patients enrolled in Medicare Advantage. SAN FRANCISCO, Aug. … [Read more...]
Five Ways Hospice Providers Use Terminally Ill Patients to Rip Off Taxpayers
Hospice care is the provision of specialized palliative treatment for terminally ill patients, focused not on curing them but making their last days as comfortable as possible. Hospice has gone from a grassroots movement on the outskirts of the U.S. … [Read more...]
Whistleblowers Stop Nursing Home Fraud and Patient Harm – With help from the False Claims Act
Healthcare fraud puts patients’ lives at risk and costs billions of dollars every year. Nursing homes, which house vulnerable patients away from loved ones and the outside world, are especially fertile breeding grounds for healthcare fraud schemes. … [Read more...]
Court embraces use of statistics to hold massive healthcare providers accountable
Healthcare fraud costs Americans as much as $300 billion a year. But uncovering fraud in a healthcare system as sprawling and complex as ours—Medicare alone processes over 1 billion claims annually from over 1 million providers—is like digging for … [Read more...]