athenahealth and Biogen Anti-Kickback Settlements

The Depart of Justice shows commitment to combatting healthcare fraud through recent multi-million settlments with companies Athena and Biogen.

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UNDERSTANDING THE ASERACARE CASE & MEDICAL NECESSITY

AseraCare is facing a whistleblower lawsuit from the US Government based on the False Claims Act. This case could set a precedent for future qui tam FCA cases, and to understand its impact we first need to understand the case itself.

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ELEVENTH CIRCUIT COURT OF APPEALS RULES ON LACK OF MEDICAL NECESSITY CASES

In United States v. AseraCare, whistleblowers and government prosecutors obtained a substantial partial verdict against AseraCare, a for-profit home hospice company. The Government argued, and the jury agreed, that AseraCare was deliberately enrolling and billing Medicare for patients who were not eligible for hospice care. The district court, however, ultimately granted summary judgment in favor of AseraCare.

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BEAVER MEDICAL GROUPS PAYS $5 MILLION TO SETTLE ALLEGATIONS OF MEDICARE ADVANTAGE FRAUD

Whistleblowers exposed Beaver Medical Group, L.P. for fraudulently misrepresenting its patients’ diagnoses to make them appear sicker in order to receive greater compensation. Ultimately, they agreed to pay the Government over $5 million and the whistleblower received $850,000. However, there was no determination of liability.

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WHISTLEBLOWERS EXPOSE HEALTHSOUTH MEDICARE FRAUD

The Department of Justice recently announced a $48 million settlement in an important case over the accuracy of the information healthcare providers give to Medicare. HealthSouth, now known as Encompass Health, misrepresented its patients’ diagnosis to Medicare to keep certain facilities qualified as “Inpatient Rehabilitation Facilities”, and to receive higher reimbursement rates for patients.

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WHISTLEBLOWER LAWSUIT RESULTS IN $1.2 MILLION SETTLEMENT PAID BY BALDWIN BONE & JOINT

Baldwin Bone & Joint P.C. faced allegations of Medicare fraud, along with accusations of violating the Physician Self-Referral Law, also known as the Stark Law. The case ruling may make it easier for whistleblowers to expose healthcare fraud in the future.

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MALLINCKRODT PAID KICKBACKS & NOW MUST PAY $15 MILLION SETTLEMENT IN WHISTLEBLOWER LAWSUIT

Whistleblowers exposed Mallinckrodt for violating The Federal Anti-Kickback Statute, alleging that from 2009-2013 the company used lavish meals and entertainment to motivate doctors to prescribe Mallinckrodt drugs. This violation of the False Claims Act resulted in a $15 million settlement.

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MILITARY SERVICE MEMBERS MAY HAVE A CLAIM FOR COMPENSATION DUE TO DEFECTIVE EARPLUGS

Thanks to the acts of a courageous whistleblower, over a decade of deception that resulted in harm to our military servicemen and women has finally been brought to light. The Department of Justice sued 3M, alleging that 3M sold the dual-ended combat arms earplugs U.S. military between 2003 and 2015, without disclosing that they were defective.

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MARRIOTT HOTELS REVEALS MASSIVE, LONG-RUNNING DATA BREACH

Recent reports indicate that third-party hackers may have stolen guest records from 500 million guests of Marriott’s Starwood hotels. This includes highly sensitive personally identifying information such as credit card numbers and expiration dates, mailing addresses, dates of birth, passport numbers, and email addresses.

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