False Claims Act

Medicare Hospice and Home Health Fraud, Part 3

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This is part three of the series of posts on hospice and home health fraud.  Parts one and two can be accessed below. https://rhislop3.com/medicare-hospice-and-home-health-fraud-part-1/ https://rhislop3.com/medicare-hospice-and-home-health-fraud-part-2/ Recent Cases and Settlements in Medicare Fraud High-Profile Hospice Fraud Convictions Several recent cases highlight the persistence of fraudulent practices in hospice care billing under Medicare. One notable example involves … Read more

Medicare Hospice and Home Health Fraud, Part 2

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Late last week, I posted the first part of a three-post, comprehensive review of Medicare hospice and home health fraud. Medicare home health and hospice billing fraud has emerged as a significant issue within the U.S. healthcare system, costing taxpayers billions of dollars annually and jeopardizing the integrity of federal health programs. This is part … Read more

DOJ Recovers $2.9 Billion in Fraud in 2024

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The Department of Justice (DOJ) announced that the agency recovered $2.9 billion in resolutions to federal False Claims Act allegations for 2024 (fiscal year ending September 30).  This is a slight increase from the historic $2.7 billion recovered in fiscal year 2023. Office of Public Affairs | False Claims Act Settlements and Judgments Exceed $2.9B … Read more

InnovAge Fraud Litigation Expands

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A Colorado federal judge last Wednesday certified a class of stockholders in a securities suit against InnovAge (https://www.innovage.com/) alleging the senior health care company made misleading statements in its initial public offering that later caused stock prices to fall post a government audit that exposed false statements. Three public pension funds based in Texas and … Read more

Federal Judge Key Ruling on False Claims Act

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On September 30, US District Judge Kathryn Kimball Mizelle from the Middle District of Florida ruled in a landmark decision that the qui tam provision of the federal False Claims Act (FCA) is unconstitutional. This ruling could have significant impact on whistleblower (Qui Tam) actions filed against healthcare providers, particularly home health and hospice (most … Read more

Healthcare Fraud is Rampant and so are Costs

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The U.S. spends more than any other world nation on healthcare – gross dollars and per capita. The systemic growth of spending continues at rate beyond inflation, spurred-on by an aging demographic and chronic diseases like diabetes and obesity.  Cost growth in programs like Medicare is rampant but then again, so is fraud. Federal spending … Read more

Hospice Fraud and Abuse Front and Center

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Since I started this site, a topical area that has been a constant for me is hospice and in particular, fraud and abuse. Recent cases have again put Hospice fraud and abuse, front and center. Thematically, the cases are different and the same in so much that they involve improper billing of hospice cases to … Read more

The Ensign Group Inc. Case Study: Nursing Home Chains Analysis

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In the midst of the Covid-19 pandemic, nursing homes across the United States faced daunting challenges. One such example is The Ensign Group Inc., the second largest for-profit chain in the country. A descriptive case study delves into the financial and quality metrics of this publicly traded U.S. nursing home chain during the age of … Read more

DOJ Gets Aggressive in Pursuit of Telehealth Fraud

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It was only a matter of time before cases involving telehealth fraud/False Claims Act cases became public.  This week, two press releases from the DOJ illustrated how aggressive the agency has become in the pursuit of telehealth related fraud. I suspect more, larger in implication (dollar value, geographic spread), will drop publicly in the next … Read more

Record-breaking $2.7 Billion Paid by Healthcare Providers in False Claims Act Cases

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A couple of weeks ago, on February 22nd. the Department of Justice issued its annual statement regarding False Claims Act activity in FY 2023 (federal fiscal years run 10/1 to 9/30). “Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023. The government and whistleblowers were … Read more