The Department of Justice (DOJ) last week reported nearly $3 billion in recoveries under the False Claims Act (FCA) for fiscal year 2024. These successful FCA cases targeted fraud in healthcare, defense contracting, pandemic relief, and cybersecurity, among other areas. A significant portion, $1.67 billion, came from healthcare fraud cases, including improper billing practices and […]
Last week, the Department of Justice (DOJ) announced a $15.875 million settlement with Booz Allen Hamilton over alleged False Claims Act (FCA) violations involving a scheme to rig Department of Defense (DoD) bids using insider information. The alleged fraud centered on a Booz Allen subsidiary, Booz Allen Hamilton Engineering Services (BES), which supplied military training […]
Right before the holidays, we proudly announced a settlement of up to $100 million with Independent Health, a Western New York-based insurer, and one of its former executives. Several news outlets have since highlighted the settlement and the importance of whistleblowers in the healthcare industry, which is unfortunately a hotbed of fraud. In its case […]
Whistleblower Partners is proud to announce that our client, Teresa Ross, and the United States, have reached a settlement with Independent Health (“IH”), a Medicare Advantage Organization in Western New York, as well as its former subsidiary, DxID, and that subsidiary’s former CEO Betsy Gaffney. The settling parties will pay up to $100 million, with […]
Whistleblower Partners attorneys represented a whistleblower in a suit that resulted in a 2024 settlement of up to $100 million with Independent Health, a Medicare Advantage Organization in Western New York. The whistleblower alleged that Independent Health, and one of its former subsidiaries called DxID, flaunted Medicare rules and submitted improper diagnosis codes to the […]
Medicare Advantage, or Medicare Part C, is an extremely popular alternate model to traditional Medicare. In traditional Medicare, the government directly pays for services provided, known as a “fee for service” model. Under the Medicare Advantage program, the government contracts with private insurers and pays them premiums to provide coverage for Medicare-eligible beneficiaries. In this […]
Medicare, like many other insurers, often pays doctors a standardized rate based on the service they performed. Open heart surgery costs $Z, a blood test for cholesterol costs $Y, and a physical costs $X. Upcoding is a fraud that centers on healthcare providers submitting improper medical codes to insurers for reimbursement, generally for improperly high […]
The basic principle of the False Claims Act (FCA) is simple. The law empowers whistleblowers to sue contractors that are allegedly defrauding the government and share in any recovery. The goal was to incentivize those with information about fraud against the government to come forward, report the fraud, help recover taxpayer dollars lost to fraud, […]
Many international whistleblowers labor under the false impression that they must be American or work in the U.S. to be eligible to participate in the various U.S. whistleblower reward programs. Whistleblower Partners attorneys Mary Inman and Ari Yampolsky spoke with Welt reporter Laurin Meyer to disabuse Welt readers of this notion and discuss the risks […]
A recent federal government report on Medicare Advantage (MA) plans reveals a concerning issue: billions of dollars are being funneled into MA companies through inflated, risk-adjusted payments based on questionable diagnoses. This situation not only drains taxpayer dollars but also raises potential issues in patient care and program integrity. If you're aware of specific misconduct […]
