In September, the U.S. Department of Health and Human Services’ Office of Inspector General issued a report raising concerns that some Medicare Advantage companies inappropriately used chart reviews and health risk assessments, or HRAs, to receive higher payments under Medicare Advantage risk adjustment. The OIG found that 20 of the country’s 162 MA companies accounted for a disproportionate share of $9.2 billion in payments from diagnoses that were only reported on chart reviews and HRAs. … [Read more...]
Record $90 Million False Claims Act Settlement with Sutter Health Announced by Keller Grover and Co-Counsel
Sutter Health's False Claims Act settlement resolves a closely watched whistleblower lawsuit alleging it violated the False Claims Act by submitting inaccurate and unsupported medical information on tens of thousands of patients enrolled in Medicare Advantage. SAN FRANCISCO, Aug. 31, 2021 /PRNewswire/ -- Keller Grover, Constantine Cannon, and Kleiman Rajaram announce the landmark $90 million False Claims Act settlement against Sutter Health on behalf of their whistleblower client, Kathy … [Read more...]
Hospice Fraud: Five Ways Providers Use Terminally Ill Patients to Rip Off Taxpayers
Hospice care is the provision of specialized palliative treatment for terminally ill patients, focused not on curing them but making their last days as comfortable as possible. Hospice has gone from a grassroots movement on the outskirts of the U.S. medical establishment to a massive, multibillion-dollar industry. And as it has come of age, it has increasingly attracted the same type of fraud, waste, and abuse that plagues U.S. healthcare at large. Hospice treatment has been covered by … [Read more...]
Nursing Home Fraud: How Whistleblowers Stop It With the False Claims Act
Healthcare fraud puts patients’ lives at risk and costs billions of dollars every year, and nursing home fraud is among its most damaging forms. Nursing homes, which house vulnerable patients away from loved ones and the outside world, are especially fertile breeding grounds for healthcare fraud schemes. While government agencies have stepped up their enforcement efforts, nursing home workers who witness fraud are in the best position to put it to a stop—and thanks to federal and state … [Read more...]
Statistical Sampling in False Claims Act Cases: Court Embraces Statistics to Hold Healthcare Providers Accountable
Healthcare fraud costs Americans as much as $300 billion a year. But uncovering fraud in a healthcare system as sprawling and complex as ours—Medicare alone processes over 1 billion claims annually from over 1 million providers—is like digging for needles in a breathtakingly huge haystack. That's why the federal government relies heavily on the False Claims Act’s qui tam provisions to encourage ordinary people to blow the whistle on fraud by filing private civil lawsuits. False Claims Act … [Read more...]