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 […]
The Securities and Exchange Commission (SEC) has outlined its examination priorities for fiscal year 2025, aiming to bolster investor protection and market integrity. These priorities serve as a crucial resource for potential whistleblowers who may witness violations within the financial sector, particularly as the SEC intensifies its focus on areas that pose risks to investors. […]
On October 10, the Department of Justice, Financial Crimes Enforcement Network (FinCEN), Federal Reserve, and Office of the Comptroller of Currency imposed over $3 billion in penalties on TD Bank. TD Bank pled guilty to violating the Bank Secrecy Act and conspiring to commit money laundering. The case is history-marking for two reasons. First, the […]
Liz Soltan recently wrote for Bloomberg Law News, analyzing the SEC’s settlement with Keurig Dr. Pepper. The settlement alleges Keurig made inaccurate statements about the recyclability of its K-cup pods. Keurig paid a $1.5 million civil penalty. Liz’s article was also included in the Daily Update email from Securities Docket. Keurig stated in its public […]
Last week brought bombshell news for all those who care about stopping fraud on the government. And it wasn’t the good kind. On September 30, Judge Kathryn Kimball Mizelle, a federal judge in Tampa, Florida, held that the qui tam provisions of the False Claims Act are unconstitutional. Those provisions allow whistleblowers to sue on […]
Several news outlets have highlighted our client’s historic $79 million whistleblower award, shared with two other whistleblowers. The award is one of the largest ever made under the IRS Whistleblower Program for exposing tax fraud, with the whistleblowers helping the government recover more than $263 million. The press coverage has focused not only on the […]
