DOJ just won another victory in the long-running Omnicare case. Back in April, the jury found that Omnicare had submitted 3.3 million false claims and was liable for damages of over $135 million. The Judge trebled that damages number, as required by the False Claims Act, reaching a final damages amount of over $406 million, […]
Genetic testing fraud enforcement has dramatically increased in recent years, and that trend continues this week with yet another suit. Recurring schemes in this space include billing Medicare for a test or screening that was 1. not medically necessary, 2. not ordered by the treating physician, and/or 3. tainted by a kickback. Medicare will cover […]
Today, the Department of Justice announced a new Antitrust Whistleblower program for antitrust violations that include actions affecting the Postal Service. Years in the making, this Program fills a significant gap in existing whistleblower programs by providing a means for individuals to report price-fixing, bid-rigging, and other antitrust conspiracies. Antitrust violations harm consumers and the […]
CVS, the largest pharmacy chain in the USA, has been accused of fraud against the Medicaid Programs of nearly 30 States. The allegations stem from a set of laws known as the “Usual and Customary” (“U&C”) requirements. U&C laws generally require pharmacies to disclose how much various customers are paying for drugs. The goal of […]
Since its launch in 1998, the Medicare Advantage (MA) program has grown rapidly, now enrolling more beneficiaries than traditional Medicare. Unlike traditional Medicare—which generally reimburses providers on a fee-for-service basis (meaning, for the services they perform)—Medicare Advantage operates through a managed care model, with private insurers receiving capitated payments based on the demographics and health […]
With dramatic steps to reshape federal agencies underway, the Department of Health and Human Services (HHS) is now at the center of a contentious overhaul. U.S. Secretary of HHS Robert F. Kennedy Jr. just announced sweeping cuts to HHS, including slashing a quarter of its ~91,000 person workforce and consolidating its 28 divisions into just […]
On April 4, Whistleblower Partners joined over 500 law firms who signed an amicus (friend of the court) brief supporting the suit filed by the law firm Perkins Coie against the Trump Administration. Unfortunately, none of the top 20 law firms in the country (based on annual revenue) signed the brief, often citing the very […]
Fraud against federally funded healthcare programs (such as Medicare or Medicaid) or the Paycheck Protection Programs (PPP) make up the bulk of suits, and recoveries, under the False Claims Act. A newly filed DOJ complaint[1] out of Idaho shows how the two can mix, and demonstrate some potential follow-on FCA effects from criminal healthcare fraud […]
Confirmation hearings for Mehmet Oz, President Trump’s choice to lead the Centers for Medicaid & Medicare Services (CMS), have begun. Since CMS administers the Medicare program, Oz’s stance on the expansion of Medicare Advantage (MA)—a privately-operated alternative to traditional Medicare—could exacerbate existing issues in the American healthcare system and open new doors for healthcare fraud. […]
President Donald Trump has frequently referred to himself as "Tariff Man." So, it’s no surprise that tariffs are at the top of the agenda for his new Administration. Trump has already aggressively imposed tariffs on a broad range of imported goods, including those from China, Canada, and Europe. These tariffs—sometimes sudden and sweeping—have disrupted global […]
