An Orange County woman has pleaded guilty to submitting more than $2.2 million in fraudulent hospice care claims to Medicare for beneficiaries who were not terminally ill. Lynn Galbraith, 60, of Anaheim, pleaded guilty to one count of health care fraud and faces a statutory maximum sentence of 10 years in federal prison at her
Monogram Health Professional Services PC and Monogram Health Inc., a Tennessee-based in-home care provider, have agreed to pay $2.4 million to resolve allegations that they violated the False Claims Act by submitting false diagnosis codes to inflate payments from the Medicare Advantage program. The settlement resolves claims that between January 2021 and December 2023, Monogram
Healthcare whistleblower settlements can make headlines for hundreds of millions of dollars. But what does the data actually show about the cases in between? If you have witnessed potential healthcare fraud, one of the questions you may eventually ask is: What happens when a whistleblower case succeeds? The answer is more complicated than the biggest
What Do Healthcare Whistleblower Cases Really Pay? 100 Cases Analyzed Read More »
Four members of a Bronx-based racketeering organization known as the “War Room” have been charged in a nine-count indictment for their roles in a wide-ranging conspiracy involving the fabrication of transportation data used to support at least $12 million in fraudulent Medicaid claims. Louis Trejo, Kenneth Garner, Harold Stevenson, and Erihk Belis are accused of
The former owner of a network of telemedicine companies has been sentenced to two years in federal prison for orchestrating a scheme that billed Medicare more than $110 million for medically unnecessary durable medical equipment and genetic testing. The defendant, who operated the companies from Massachusetts, was also ordered to pay restitution and forfeit assets
A former branch manager at a Brooklyn-based bank has been sentenced to federal prison for his role in laundering the proceeds of a healthcare fraud scheme that targeted Medicare. The defendant, whose name and sentence are detailed in the Justice Department’s announcement, was convicted of conspiring to launder money obtained through fraudulent Medicare billing. According
The United States has formally intervened in a qui tam whistleblower lawsuit accusing three Colorado healthcare companies and two individuals of systematically inflating reimbursements from Medicare and TRICARE. The defendants named in the government’s complaint are Front Range Urgent Care, Comfort Care Family Practice, QwikCareMD, Anita Weiscamp, and Dr. Steven L. Wenrich. According to the
Veloxis Pharmaceuticals Inc., a North Carolina-based drug manufacturer, has agreed to pay more than $46 million to resolve criminal and civil allegations that it paid illegal kickbacks to induce prescriptions of Envarsus XR, a kidney transplant immunosuppression drug. The resolution includes a deferred prosecution agreement filed in the District of Massachusetts charging the company with
The DOJ-OIG Guidelines establish frameworks for detecting and deterring fraud, waste, and abuse in federal healthcare programs. They provide voluntary compliance guidance to help healthcare entities design effective programs that prevent violations of the False Claims Act, Anti-Kickback Statute, and other federal laws. The General Compliance Program Guidance (GCPG) covers seven core elements of an
More than 30 states have enacted False Claims Acts, but their strength varies dramatically. California offers the nation’s largest whistleblower reward—up to 50% of total recovery, far exceeding the federal 15-30% range—and covers fraud against private insurers. New York has recovered over $4 billion since 2011 and applies its FCA broadly to “almost any situation
