(Reuters)—The U.S. Justice Department (DOJ) has accused UnitedHealth Group Inc. of obtaining inflated payments from the government based on inaccurate information about the health status of patients enrolled in its largest Medicare Advantage Plan.1 The complaint, filed in federal court in Los Angeles on Monday, came after the DOJ earlier this year intervened in two…
New York City Hospitals Settle Medicaid Repayment after Fraud Charges
NEW YORK (Reuters)—Three hospitals in New York’s Mount Sinai Health System will pay $2.95 million to settle Medicaid fraud charges for taking two years to repay more than $844,000 of improper billings that had been flagged by a whistleblower, authorities say on Wednesday. The accord resolves claims that Mount Sinai Beth Israel, Mount Sinai St….
Five Charged in $600 million California Healthcare Fraud Scheme
LOS ANGELES (Reuters)—The former chief financial officer of a California hospital and four other people have been charged in a series of health care kickback schemes that generated nearly $600 million in fraudulent billings for spinal surgeries, prosecutors said on Tuesday. All five defendants have agreed to cooperate in a wide-ranging federal investigation into the…
Novartis to Pay $390 Million in U.S. Settlement over Pharmacy Kickbacks
WASHINGTON (Reuters)—Novartis Pharmaceuticals Corp. will pay $390 million to settle U.S. charges that it paid specialty pharmacies illegal kickbacks in exchange for inducing patients to refill certain medications, according to an accord announced Friday. The settlement between a U.S. unit of Swiss drugmaker Novartis AG, the federal government and more than 40 states concerns payments…
Adventist Health System to Pay $118 Million to Settle Fraud Claims
(Reuters)—Florida-based healthcare system Adventist Health System has agreed to pay $118.7 million to settle a whistleblower lawsuit that accused it of paying kickbacks to doctors in exchange for referrals, attorneys for the plaintiffs announced on Monday. The agreement comes in a lawsuit filed by three former employees of Adventist’s Park Ridge Health hospital in Hendersonville,…
Five Most Important Fraud, Abuse Laws Applicable to Physicians
Know what’s included in the federal False Claims Act, Anti-Kickback Statute and other regulations and guidelines to prevent Medicare abuse
Rheuminations: Fraud Casts a Pall on Medical Research
The history, causes, and effects of scientific misconduct and strategies to reduce fraud and plagiarism in clinical medicine