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 against IH, the government alleged “that Independent Health, DxID and Gaffney violated the False Claims Act by submitting or causing the submission of inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans in order to increase Independent Health’s reimbursement.”
The Buffalo News, Defendants’ hometown newspaper, published a substantive, detailed description of the suit. They also interviewed our client, Teresa Ross, who explained that the suit started when “[She] and others did some audits, and they're like, 'These are not going to pass muster.’” The paper also interviewed partner Mary Inman, who was on the team representing Ross. Inman highlighted the role of whistleblowers in detecting healthcare frauds. DOJ’s fraud statistics underscore Inman’s point: in the past five years alone, whistleblower-filed cases have recovered over $10 billion in healthcare payments that were fraudulently claimed from the government.
KFF Health News, which has been covering Medicare Advantage litigation since its inception, also wrote on the settlement. The story noted that “[t]he settlement is the latest in a whirl of whistleblower actions alleging billing fraud by a Medicare Advantage insurer.” Ross, who spoke to reporter Fred Schulte, added that “Billions of dollars are being paid out by CMS for diagnoses that don’t exist.” The story also quoted Partners Mike Ronickher and Max Voldman, who were on the team representing Ross.
STAT News also covered the settlement, highlighting that this was the first settlement with a vendor in the Medicare Advantage industry. More common defendants have been insurers or healthcare providers. Ross noted her reaction to the vendor’s promises: “if it sounds too good to be true, it probably is. That’s what this was.” Voldman was also quoted in the story.
Bloomberg, Healthcare Dive, WIVB 4 (local CBS affiliate), The Rochester Democrat & Chronicle, Buffalo Business First, Modern Healthcare, and Law360 also reported on the settlement.
Whistleblower Partners is a boutique law firm dedicated solely to representing whistleblowers under government reward programs. We've represented hundreds of whistleblowers who have helped return billions of dollars to the government.
This is the fifth successful settlement in which Whistleblower Partners attorneys have represented whistleblowers alleging risk adjustment fraud. Whistleblower Partners attorneys continue to pursue similar charges against UnitedHealth Group and Kaiser Permanente, which are poised to be two of the largest intervened risk-adjustment cases in history. We have significant experience representing qui tam relators in healthcare fraud cases. If you would like more information or would like to speak to an attorney at Whistleblower Partners, please contact us for a confidential consultation.
