A lawsuit filed last week by the Department of Justice brings attention to a seldom litigated allegation of fraud against the government: manipulation of a health plan’s Medical Loss Ratio (“MLR”). In general, an MLR is what percentage of premiums a health plan is legally required to spend on patient care, as opposed to money […]

In a recent decision out of the Seventh Circuit, the court upheld a jury verdict that resulted in a $183 million False Claims Act award against Eli Lilly (“Lilly”), the pharmaceutical company. The case, United States ex. rel Streck v. Eli Lilly, was brought by a whistleblower named Ronald Streck, who litigated the case after […]

Medicare, the government-funded insurance program for the elderly and disabled, covers certain wound care products known as skin substitutes, basically artificial skin that’s used to replace damaged or missing skin. A new report by the Office of Inspector General draws attention to skyrocketing costs and potential fraud in the industry. In just two years, Medicare […]