• Ex-Employee Blows Whistle on California’s Largest Nursing Home Provider

    Following an investigation that arose from a whistleblower suit, the corporate owner of four San Diego-area nursing homes has agreed to pay $6.9 million to resolve multiple fraud allegations. The sister facilities, owned by Los-Angeles based Brius Management Co., purportedly paid illegal kickbacks to cultivate patient referrals and subsequently file numerous false claims to Medicare […]

  • Bribery, Kickbacks, and Fraud – Oh My! California Settles Largest Medical Fraud at an Unprecedented $600 Million

    In what is being called the largest in California history, a now-defunct Long Beach hospital has been discovered to have engaged in an egregious healthcare fraud scandal – one that resulted in up to $600 million in claims being filed and consequently reimbursed. Pacific Hospital was involved in a variety of unscrupulous financial relationships in […]

  • Registered Nurse Defrauds Medicare for $17M in Home Healthcare Scheme

    A registered nurse based out of Texas was found to have utilized two separate home healthcare clinics to swindle the federal Medicare program for $17 million over the course of the seven-year scheme. The nurse, a resident of Fort Bend, Texas, owned and operated Preferred Health Services Inc. and Deligent Health Services Inc., both based […]

  • Massachusetts Home Health Facilities Pay Out $14M for False Claims

    A multi-facility home healthcare chain has reached a $14 million settlement to resolve claims which assert their role in a large-scale scheme to defraud MassHealth, Massachusetts’s Medicaid program. From 2010 to 2016, Centrus Premium Home Care Inc. was found to have submitted an array of improper claims regarding medically unnecessary services that are not covered […]

  • Nation’s Largest Healthcare Fraud Settlement Doesn’t Stop Medical Behemoth

    Even fifteen years after their colossal 2002 payout, which is still recognized as the largest fraud settlement in United States history, Hospital Corporation of America (HCA) remains a frequent topic of discussion at the Department of Justice. Surely, it’s not hard to see why; HCA owns and operates 162 hospitals and 113 surgery facilities, the […]

  • First Settlement of Its Kind Holds Medical Facility Accountable for AKS Violation

    The emergency transportation industry is well-known for being a hotbed of fraud, especially in cases involving shady alliances made with medical facilities; when it comes to settlements involving these schemes, allegations are generally brought against the ambulance companies themselves rather than their counterparts in the agreement – until now. In what is believed to be […]

  • Four Hospitals Pay $8.6M to Settle Allegations of Kickbacks, Ambulance Fraud

    In a case brought to light by three whistleblowers, four Texas-based hospitals were alleged to have been paid a substantial amount of kickbacks from an array of emergency transportation providers in exchange for Medicare and Medicaid referrals. This practice, a direct violation of the Anti-Kickback Statute, resulted in the four hospitals paying $8.6 million to […]

  • Texas Company’s Blatant Fraud: The $51,952 Ambulance Ride That Wasn’t

    A team of brothers based out of Houston, Texas were recently found to have committed multiple counts of fraud by using their healthcare company to submit over $6 million in false claims to Medicare, Medicaid, and TRICARE. The pair billed the three government programs for services that were not provided, utilizing fraudulent certifications from physicians […]

  • Texas Doctor Bilks Medicare for Nearly $400 Million in Large-Scale Fraud, Forgery Scheme

    In an exceptionally heinous example of home healthcare fraud, seven doctors have been apprehended for their roles in a conspiracy to defraud both Medicare and Medicaid alike; altogether, they have been ordered to pay over $342 million in restitution to recover the money bilked by the extensive false claims submitted over the course of the […]

  • Texas-Based Home Healthcare Facilities Work Together to Defraud Medicare

    In what is being called the “largest criminal health care fraud takedown in the history of the Department of Justice,” three separate home healthcare facilities were found to have been separately billing Medicare for the same services – which were oftentimes not provided or medically necessary – resulting in the government program paying over $40 […]

  • Subacute Nursing Home Provides Substandard Care

    A small-town nursing home recently agreed to pay a sum of $888,000 to resolve allegations that they had provided substandard or “worthless” care to patients over the course of a two-year Medicaid fraud scheme. From July 2010 to December 2012, Andover Subacute and Rehab Center Services Two Inc. billed New York Medicaid for treatments that […]

  • Brooklyn Clinic “Employs” Homeless in $70M Medicare Fraud Scheme

    As if Medicaid fraud didn’t already victimize the nation’s most needy and impoverished individuals as it is, the now-former owner of a Brooklyn-based healthcare clinic figured out how to further abuse these individuals in the pursuit of lining his own pockets. Over the course of nine years, Victor Lipkin and eight others would recruit and […]

  • Pharma Monster Mylan Dodges Medicaid, Violates False Claims Act

    In August of 2017, the massive pharmaceutical conglomerate Mylan underwent allegations that they deliberately violated the False Claims Act in order to avoid paying Medicaid rebates, resulting in a $465 million settlement. According to the Department of Justice, the company misclassified their pioneer drug, EpiPen, as a generic in order to avoid paying appropriate Medicaid […]

  • Alabama Physician Files Duplicate Claims for Maximum Reimbursement

    A $1.4 million settlement ended a year-long suit which alleged that an Alabama physician repeatedly filed false claims to Medicaid, Medicare, and TRICARE, often for procedures that were medically unnecessary. James Crumb, the Mobile-based practitioner who specialized in Mobility Metabolism and Wellness, was found to have filed up to thirty identical false claims for a […]

  • Hospice Fraud: The Staggering Figures

    From 2000 to 2011, Medicare has seen a 300% increase in hospice payments, a figure that has only grown since. The question remains – why is hospice so widely targeted when it comes to fraudulent schemes? Well, simply put, it seems an easy target. As evidenced by the amount of money Medicare shells out to […]

  • Kickbacks Prove That Sharing Is Not Always Caring

    A $42 million settlement marks the end of a four-year investigation which alleged that PAMC Ltd. And Pacific Alliance Medical Center, Inc. together submitted false claims to both the federal government and the State of California and consequently used the reimbursements to violate the Anti-Kickback Statue and Stark Laws. The settlement will be split between […]

  • When Family Ties Lead to Corruption: A Story of Fraud

    In a twisted example of “family bonding,” a mother-and-son team were found to have together violated the False Claims Act by submitting over $25.2 million in claims to Medicare over the course of six years, the majority of which were discovered to be fraudulent. From 2009 to 2015, the pair committed large-scale Medicare fraud through […]

  • Nation’s Largest Nursing Home Therapy Provider Pays $125 Million False Claims Act Settlement

    The largest national nursing home therapy provider and its subsidiaries have agreed to pay $125 million to settle federal allegations which claim that it provided unreasonable and unnecessary services to patients in order to receive increased Medicare reimbursements, thus violating the False Claims Act. Kentucky-based RehabCare Group Inc. and its parent company, Kindred Healthcare Inc., […]

  • Georgia Hospital Settles Ambulance Fraud Case

    The most common types of ambulance fraud are upcoming the billing of Medicare or Medicaid at inflated rates, or for rides that are not medically necessary. This was the case in the recent settlement involving Navicent Health Inc., a healthcare facility that operates the second-largest hospital in Georgia, as well as their own line of […]

  • Ambulance Fraud: The Most Expensive Ride of Your Life

    Ambulance fraud is a False Claims Act violation that can take on many forms. Common types of fraud include emergency transport companies fraudulently charging Medicare or Medicaid for rides that are not eligible for reimbursement or upcoding in order to receive higher reimbursement not justified by the ambulatory services provided. These schemes result in a […]

  • Texas Home Health Agency Paid Patient Recruiters Illegal Kickbacks

    After a nine-year conspiracy, a Houston-based home health agency has finally been brought to justice after defrauding Medicare for over $13 million; it was found that, between February 2006 and June 2015, the agency submitted falsified medical records and paid kickbacks to patient recruiters, physicians, and Medicare beneficiaries in order to bilk Medicare for services […]

  • Pennsylvania Hospice Defrauds Medicare By Preying on Elderly Patients

    Six years after the initial complaint, a hospice provider was brought to justice after being found to have conspired to defraud Medicare of more than $9 million. In order to receive these fraudulent reimbursements, the hospice, Home Care Hospice, Inc. (HCH), accepted dozens of patients that did not qualify for Medicare benefits, falsifying documents as […]

  • Understanding Hospice Fraud and Why It Is So Detrimental to Late-Life Care

    In order to fully grasp the seriousness of Medicare fraud, primarily that pertaining to hospice care, it’s important to discuss the entire purpose for hospice: to provide end-of-life care for those deemed to be terminal. Once a patient is considered qualified for hospice, Medicare no longer provides curative medical care which would ordinarily treat or […]

  • It Only Takes One Bad Egg to Spoil the Whole Basket

    Hospice care was contrived out of the desire to create a model for end-of-life quality, and generally speaking, hospice facilities provide such care without issue. To do so, these facilities generally encompass a team-oriented approach, with focuses on pain management, emotional support, and spiritual devotion – all of which are expertly tailored to the needs […]

  • California Hospice Defrauds Medicare by Stretching Patient Life Expectancies

    When a program created to provide important end-of-life services is so often the victim of fraud, should we blame the broken system itself, or instead turn focus to those committing the fraudulent acts? It seems an easy question to answer, but describes the ongoing situation of hospice care – a system which regularly undergoes scrutiny […]

  • When Greed Goes Too Far: As Hospice Fraud Skyrockets, Death Toll Rises

    A large-scale fraud scheme uncovered earlier this year sheds light on just how vile healthcare administrators can be in their pursuit of financial gain. Novus and Optim Health Services, a hospice provider based in Texas, were found to have submitted over $60 million in false claims to both Medicare and Medicaid – a scheme that […]

  • India’s Whistleblower Protection Act: Progress or Pandering?

    2014 was a very exciting time for the Indian economy: with the world’s second-largest workforce, low wages, a burgeoning number of well-educated and tech savvy young people, and an ostensibly populist government committed to economic growth, India is much like the China of the late 20th century — one of the premiere destinations for global […]

  • Yara International: This Fertilizer Giant Reeks Of Corruption

    Yara International, a Norwegian based fertilizer company was found guilty in January 2014 of corruption charges from deals in Libya, India and Russia. Yara is the global leader in fertilizer production, with $14 billion in revenue in 2012. The company was ordered to pay $48 million in fines to the Norwegian government- the largest corporate […]

  • FCPA Settlement: Tyco International, Once Again

    In September of 2012, Tyco International agreed to pay more than $26 million in penalties to settle charges from the US Department of Justice and Securities Exchange Commission of violating the Foreign Corrupt Practices Act (FCPA). Between 2000 and 2008, numerous Tyco subsidiaries around the world paid hundreds of thousands of dollars in bribes to […]

  • FCPA Settlement: Oracle’s Appearance Of Impropriety

    In August of 2012, Oracle settled charges of civil violations of the Foreign Corrupt Practices Act with the SEC for $2 million. According to the SEC press release: The SEC alleges that certain employees of the India subsidiary of the Redwood Shores, Calif.-based enterprise systems firm structured transactions with India’s government on more than a […]

  • FCPA & Bribery: Travel Expenses Neither “Reasonable” Nor “Bona Fide”

    Travel expenditures have long been, and continue to be, a popular way of facilitating bribes. First, the travel accommodations themselves can function as a bribe- flying foreign officials first class to exotic destinations and pampering them with luxury hotels, meals, and so forth. Second, the travel expense accounts can be exaggerated and kicked back to […]

  • The FCPA & Facilitating Payments

    In a number of our articles on the Foreign Corrupt Practices Act (FCPA), we have touched on several exemptions and “affirmative defenses” in the law. (An affirmative defense is a defense where the defendant proves a set facts that mitigate or excuse otherwise unlawful behavior.) The two affirmative defenses permitted by the FCPA are very […]

  • Dual Enforcement of the FCPA

    Enforcement of the Foreign Corrupt Practices Act is carried out by two agencies: the Department of Justice, and the Securities Exchange Commission. Though each agency is granted jurisdiction over different types of violations and different classes of persons and corporations, in practice the two agencies typically work in cooperation to further the interests of the […]

  • What Is A Trust?

    In discussing offshore tax havens, a term that frequently arises is trust.  In a legal context, a trust is a relationship where one party holds another party’s property.  The settlor turns over control of assets to a trustee, the individual(s) in charge of holding the assets.  The trustee is in charge of disbursing the property […]

  • What Is A Tax Haven?

    This fundamental question is difficult to answer succinctly because there is no legal definition nor a universally agreed-upon definition.  The Organisation for Economic Co-operation and Development (OECD), an international organization created to promote trade and economic progress between democratic governments, has identified several key features which make a country a tax haven: “no or low […]

  • Tax Fraud: Let Us Count (Some Of) The Ways …

    The primary challenge posed by tax havens is the secrecy that obscures money once it has gone offshore. Most tax havens have strict secrecy laws that prohibit the disclosure of financial information to foreign parties. For example, if the IRS suspects you have undisclosed assets in a US account, they can easily get an order […]

  • Money Laundering 101

    One of the drawbacks of earning or spending money illicitly is that it is hard to use this money for legitimate purposes, except in small amounts. If I make a small amount of cash from selling drugs, I can spend this cash fairly freely. I can probably even deposit small amounts of it into my […]

  • History Of Tax Havens: Switzerland

    In our article Are Tax Havens Inherently Bad?, we briefly discussed some of the legitimate uses of tax havens and the ethical justifications for their existence. A tax haven with strict secrecy laws can serve as a safeguard of individual rights against an abusive or unstable state. This came to the forefront in Europe during […]

  • History Of Tax Havens: New Jersey’s Easy Incorporation Laws

    To better understand the current state of tax havens, and perhaps to predict in some way where they are headed in the future, it is helpful to look at the history of their development. While the term tax haven can be rather ambiguous, there are certain key features that underlie them: secrecy, low taxation, and […]

  • Are Tax Havens Inherently Bad?

    In short- no, not inherently. Tax havens are a tool. And like any tool, they can be used for legitimate purposes, or misused. The primary problem with tax havens is their most important, perhaps defining feature: secrecy and non-transparency. “Secrecy and non-transparency” certainly sounds a bit nefarious, however. We could just as easily use the […]

  • Birth Of The FCPA: This Bribery Is Positively Bananas

    Every so often we see on the news reports of heinously unethical behavior that conclude with an infuriating detail- the behavior, while clearly immoral, isn’t technically illegal. Citizens get up in arms and demand to know “how is this legal?!” To placate outraged constituents, legislators call Congressional hearings and hear experts testify on how best […]

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