Category:

Fraud & Abuse

Hurricane Harvey Aftermath Leaves Opportunity for Financial Fraud

On August 30, 2017, Trump signed Proclamation 9632 declaring September 2017 as National Preparedness Month, encouraging “all Americans… take action to be prepared for disaster or emergency by making and practicing their plans,” also citing that fewer than half of American families report having an emergency response plan. While it is important to have a disaster plan in place for your family to take care of their physical needs, it is also vital to be prepared for the possibility of scams and fraudulent activity in the wake of a natural disaster such as Hurricane Harvey.

My Summer with the Office of Inspector General for the U.S. Department of Health and Human Services

This summer I had the opportunity to intern with the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) in Washington, DC. I thoroughly enjoyed my time with OIG, and I learned a great deal about health care fraud, waste, and abuse. In spending my summer with OIG, I had a glimpse into the powerful regulatory bodies that protect the health care market from abuse. As I move forward with my career in regulatory work, I will take with me the invaluable experiences and skills from my internship.

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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