Author Archives: Site Administrator
Reverse Mortgage Fraud & the False Claims Act
Reverse mortgage fraud is on the rise, and taxpayers are paying the bill. How? A reverse mortgage is a type of home equity loan available only to elderly borrowers who have a large amount of equity in their homes. Essentially, the borrower cashes out the equity by taking a loan, usually paid to the… Read More »
Waiver of Co-Payments & Deductibles
In most cases, Medicare does not pay for 100% of covered medical items or services. Most commonly, Medicare covers only 80%. The remaining 20% must be paid by the Medicare beneficiary as a form of co-insurance or co-payment. Medicare beneficiaries might have supplemental insurance policies that pay for part or all of this 20%… Read More »
Using Company Documents to Prove the Fraud
A recent case in Illinois highlights a common battleground in qui tam whistleblower cases namely, the whistleblower who keeps and relies upon company documents to prove the fraud allegations of his or her complaint. In Shmushkovich v. Home Bound Healthcare, Inc., 2015 WL 3896947 (N.D. Ill. June 23, 2015), a whistleblower brought a qui… Read More »
Compounded Pain Creams and Gels
As recently reported by CBS News, federal authorities are currently investigating widespread fraud occurring in the area of compounded pharmaceuticals and compounding pharmacies. Compounding refers to the process by which medications can be turned into topical creams, ointments and gels. Many pharmacies specialize in the manufacture of compounded medications, especially compounded pain and scar… Read More »
Whistleblowers and HIPAA
Whistleblowers often face a difficult decision when they suspect fraud at their place of employment. The whistleblower knows that fraud is being committed, but he or she will never be able to prove it without keeping or retaining documents and records that might be protected by the Health Insurance Portability and Accountability Act, more… Read More »
Contractor Settles Suit Related to Set Aside Contracts
According to the Department of Justice, LB&B Associates, Inc. (“LB&B”) has agreed to settle a qui tam lawsuit alleging it violated the False Claims Act by claiming it qualified as a Small Disadvantaged Business when it did not. LB&B is a North Carolina corporation that was formed in 1992 and is headquartered in Columbia,… Read More »
IRS places Captive Insurance Companies on the list of the “Dirty Dozen”
Each year the IRS publishes a list of the “Dirty Dozen” tax scams. The list is intended to warn taxpayers against common and trending tax scams. The complete list for 2015 can be found by clicking here. The 2015 list includes the improper use of captive insurance companies to shelter income from the IRS…. Read More »
Education Company Agrees to Settle Five Qui Tam Cases
According to the Department of Justice, a for-profit education company based in Baltimore, Maryland, Education Affiliates (“EA”), has agreed to settle five qui tam cases alleging the company submitted fraudulent claims to the U.S. Department of Education in violation of the False Claims Act. According to EA’s website, it offers post-secondary education programs at… Read More »
Helpful Whistleblower Decision from D.C. Circuit
On June 23, 2015, the United States Court of Appeals for the District of Columbia Circuit issued a helpful decision for qui tam whistleblowers in U.S. ex rel Heath v. AT&T, Inc., Case No. 14– 7094, 2015 WL 3852180 (D.C. Cir. 2015). The issue concerns the level of factual detail that a whistleblower must… Read More »
Largest Healthcare Fraud Takedown in Justice Department History
According to the Justice Department, the Medicare Fraud Strike Force conducted a nationwide operation in 17 cities this week. The sweep resulted in criminal charges against 243 individuals for their alleged participation in healthcare fraud schemes involving over $700 million in false billings to government healthcare programs. Forty-six (46) of the individuals were doctors,… Read More »