Tag:DOJ
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.
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 …
Read more
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 …
Read more
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 …
Read more
Lessons Still to be Learned from Settlements of Implantable Cardiac Device Cases
Gail Jankowski Executive Editor Loyola University Chicago School of Law, JD 2016 Although the DOJ reached 70 settlements involving 457 hospitals in 43 states for more than $250 million related to cardiac devices that were implanted in Medicare patients which violated coverage requirements, they were not done yet. Another batch of 51 hospitals settled …
Read more