ABA Therapy Fraud and the False Claims Act Applied Behavior Analysis (ABA) therapy is a widely used treatment for children diagnosed with autism spectrum disorder, with Medicaid and private insurers spending billions each year on these services. While ABA therapy can provide legitimate benefits when properly administered, recent federal audits have identified widespread billing irregularities and compliance failures in the ABA therapy industry. These findings raise serious questions about … [Read more...]
Prescription Drug Pricing Fraud and the Role of Whistleblowers
Mentioning health care costs is a sure-fire way to set someone on a rant, and prescription drug prices consistently rank among the most common frustrations for patients and families. In recent polling by KFF examining the prior year, nearly one in four adults reported taking an over-the-counter medication instead of a prescribed drug due to cost concerns. One in five said they did not fill a prescription because of the expense. Approximately one in seven adults reported cutting pills in half … [Read more...]
Whistleblowers Can Protect the U.S. From Bad Actors and Be Rewarded
A fledgling whistleblower program rewards individuals — whether U.S. citizens or not — who alert the United States about efforts to evade sanctions. It’s particularly relevant today, and it’s not as out of reach as it sounds. Stick with us — we’ll explain. What’s happening with sanctions? When the United States wants to discourage certain behaviors (such as Russia’s war on Ukraine), one of the levers it can pull is sanctions. That can involve political or economic restrictions: freezing … [Read more...]
Medicaid Fraud Control Units and the Role of Whistleblowers
The expansive Medicaid program spent approximately $909 billion in fiscal year 2024. To help cover health care costs for eligible low-income individuals, the federal government contributes the majority of this funding, while state governments supply the remaining portion. Large government programs often face a significant challenge: fraud. Even so, overall civil settlements, judgments, and recoveries related to Medicaid fraud have trended downward since 2016. Civil fraud cases commonly … [Read more...]
California Medi-Cal Fraud and the Importance of Whistleblowers
The owners of three medical companies agreed to a $10 million settlement in January to resolve allegations of a kickback scheme that caused false claims to Medicaid and Medi-Cal. California receives $4 million from the settlement. Earlier this year, a pharmaceutical manufacturer and its chief executive officer agreed to a $47 million settlement related to similar allegations. California will receive nearly $385,000. We often discuss the importance of whistleblowers in uncovering billions … [Read more...]
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