Category:Fraud & Abuse
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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The New Medicaid Managed Care Rule and Its Effects on Compliance Programs
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 The Centers for Medicare and Medicaid Services (CMS) recently published a new rule for state contracts with Medicaid Managed Care Organizations (MCO). Medicaid MCOs provide comprehensive services to beneficiaries for capitated payments. The effective date of the rule was July 5, 2016. …
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False Claims Act Penalties Double with DOJ New Interim Rule
Amanda Bogle Executive Editor Loyola University Chicago School of Law, JD 2017 On June 30, 2016, the Department of Justice joined other agencies in passing a new interim final rule, significantly increasing the penalties for the False Claims Act (FCA). Before, FCA penalties ranged from $5,500 up to $11,000 per false claim. The new …
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Implied Certification: What does it mean for your small business?
Brittany Tomkies Executive Editor Loyola University Chicago School of Law, JD 2017 In a monumental decision for false claims cases, the Supreme Court of the United States (SCOTUS) unanimously affirmed the viability of the implied certification theory. The ramifications of this ruling may create additional stressors on small businesses and will likely create additional …
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