Three whistleblowers will share more than $2.7 million in rewards for helping the government uncover false claims for 3D reconstructions of CT scans and other diagnostic tests.
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Three whistleblowers will share more than $2.7 million in rewards for helping the government uncover false claims for 3D reconstructions of CT scans and other diagnostic tests.
The federal government recovered more than $4.3 billion from companies and individuals who were accused of healthcare fraud last year. Of that amount, $3.75 billion – or 87% of the total – was recovered from pharmaceutical companies.
FALSE CLAIMS ACT WHISTLEBLOWER WILL RECEIVE A $400,000 REWARD
CRIMINAL PROSECUTIONS INCREASE SINCE MAYOR DE BLASIO TOOK OFFICE
The federal government has joined eight whistleblower lawsuits alleging that Health Management Associates Inc. (HMA) billed federal health care programs for medically unnecessary inpatient admissions from the emergency departments at HMA hospitals. The lawsuits also allege that HMA paid kickbacks to doctors for inpatient admissions and referrals.
A 35 year old Emergency Medical Technician (EMT) is facing up to 10 years in prison, a $250,000 fine, and other penalties for creating false run sheets or trip reports that were used to bill Medicare and Medicaid for ambulance services.
New clients call me every day when they receive a letter from the Bureau of Fraud Investigation at the NYC Human Resources Administration. The letter says that their eligibility for Medicaid or Family Health Plus is being investigated.
When the government investigates and prosecutes Medicare fraud, it has tremendous resources at its disposal.
Comparing dispensing data with purchasing data has become an important tool for Medicaid fraud investigators throughout the country, especially in investigations into pharmacists, pharmacies, and durable medical equipment (DME) supply companies.
The defendants admitted that they submitted false claims to Medicare by billing multiple times for physician supervision on days when the physician supervised only one HBOT session.
The United States Government has joined a whistleblower lawsuit against PharMerica Corp. That alleges the company caused flase claims to be submitted to Medicare. If the government wins the lawsuit, the whistleblower will be entitled to a reward of between 15% and 25% of the amount the government recovers.
The doctor was arrested and charged with two counts of Criminal Sale of a Prescription for a Controlled Substance in violation of New York Penal Law § 220.65. These are Class C felony charges. If convicted, the doctor faces up to 15 years in prison on each count. He also faces loss of his medical license, exclusion from the Medicare and Medicaid program, and other consequences.
The Bureau of Fraud Investigation conducts investigations of individuals and families who are suspected of providing false information on their applications and re-certifications for Medicaid, Family Health Plus, and other social services programs.
New York courts have held that individuals and their families do not automatically lose their New York residence status for Medicaid eligibility purposes merely by leaving the state, even if they remain outside the state for a substantial period of time.
Every year, the Bureau of Fraud Investigation conducts investigations and interviews of more than 5,000 New York City residents about their eligibility for Medicaid.
State and federal governments have made Medicaid fraud investigations a top priority. In New York City alone, more than 5,000 individuals are investigated every year for receiving Medicaid benefits they were not eligible to receive. Some of the more common types of Medicaid fraud include failing to report your actual income on an application or recertification, failing to include income from a spouse or rent received from a tenant, and failing to disclose your actual place of residence.
If you received a letter from the NYC Human Resources Administration (HRA) stating that you are under investigation concerning your eligibility for Medicaid, then you must act quickly to avoid potentially devastating consequences.
By the time you receive that letter, investigators from the HRA's Bureau of Fraud Investigation have already gathered information about your income, assets, employment, and living arrangements.