Category:

Fraud & Abuse

DOJ Joins Whistleblower Suit Against UnitedHealth Group

The United States Department of Justice (“DOJ”) recently intervened in a qui tam action against UnitedHealth Group (“United”) and its subsidiary, UnitedHealthcare Medicare & Retirement, the nation’s largest provider of Medicare Advantage (“MA”) Plans. The suit alleges that United engaged in an “up-coding” scheme to receive higher payments than they should have under MA’s risk adjustment program. Assuming these allegations of United’s false claims are true, then United billed and received hundreds of millions of dollars in improper payments from Medicare.

The Baxter Settlement and its Implications for FCA Liability

Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017   In January, Baxter Healthcare Corporation (“Baxter”) agreed to pay $18,158 million after the Department of Justice (DOJ) brought suit for violating the Food, Drug, and Cosmetic Act (FCDA) and the False Claims Act (FCA). The Baxter case is unique because it was …
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The SEC’s Whistleblower Program Proves Resilient Despite Adversity

Lauren Rushing Associate Editor Loyola University Chicago School of Law, J.D. 2018   In the span of one week, two financial services companies paid penalty fees to the Securities and Exchange Commission for intentionally undercutting the Whistleblower Program. Impeding whistleblower communication is averse to quashing misconduct in the marketplace, which is the program’s main goal. …
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Mother and Son Sentenced to Federal Prison for Pharmacy Fraud Scheme

Anais Holland-Rudd Associate Editor Loyola University Chicago School of Law, JD 2018   Niurka Fernandez, 54, and her son Roberto Alvarez, 26, both plead guilty on August 31, 2016 to one count of conspiracy to commit health care fraud. On November 10th, Fernandez was sentenced to 120 months in prison while Alvarez was sentenced to …
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New Era of Healthcare Fraud Investigations Focuses On Individual Accountability

Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017   Traditionally, only healthcare corporations were held responsible for healthcare fraud. During an investigation, these corporations were only required to provide contextual information about the underlying factual situation in a fraud investigation. Additionally, healthcare corporations would typically enter into settlement agreements with the …
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Two Former Nursing Home Executives and Two Accomplices Steal Over $16 Million Through Kickbacks and Overcharges

Alexander Thompson Associate Editor Loyola University Chicago School of Law, J.D. 2018   Two former executives of American Senior Communities and two accomplices have been indicted on numerous charges by the Department of Justice. The two former executives: CEO James Burkhart and Daniel Benson were arraigned on charges of health care fraud and conspiracy to …
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Federal Jury Convicts Home Health Services Agency for Multimillion Dollar Healthcare Fraud Conspiracy

Anais Holland-Rudd Associate Editor Loyola University Chicago School of Law, JD 2018     Pillar Garcia Lorenzo, (Lorenzo), former owner of Gold Care Home Health Services (Gold Care) located in Tampa, Florida was convicted by a federal jury on Thursday, October 6th, 2016 due to her role in a conspiracy to commit health care fraud …
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Tenet Healthcare Medicaid Kick-Back Settles for $514M

Mac Matarieh Associate Editor Loyola University Chicago School of Law, JD 2018   On October 3, 2016 Tenet Healthcare Corporation (Tenet) announced that they have reached a settlement with the United States Government for $514 million. The settlement stems from a violation of the anti-kickback law by four of Tenet’s hospital subsidiaries. The hospitals allegedly …
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Medicare Advantage Audits Reveal Alleged Rampant Upcoding

Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017   Last month, the Center for Public Integrity obtained over three-dozen new Medicare Advantage (MA) audits through a lawsuit brought under the Freedom of Information Act. The audits indicate that overcharging is still a pervasive problem in the MA Program because Medicare Advantage …
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Another Suit against Vanguard Healthcare

Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017   In 2011, Vanguard Healthcare, LLC (“Vanguard”) settled a whistleblower suit for Medicare and Medicaid fraud and entered into a Corporate Integrity Agreement (CIA). Now the federal government is suing Vanguard for submitting fraudulent claims for services that were “either non-existent or grossly …
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