Federal prosecutors in the Southern District of Texas have secured substantial prison sentences for two healthcare employees convicted in a multimillion-dollar fraud scheme that targeted elderly and vulnerable patients at adult day care facilities. A federal jury found Dr. Osama Nahas and clinic employee Isabel Pruneda guilty of conspiracy to commit healthcare fraud, healthcare fraud, […]
The Pennsylvania Attorney General’s Office recently secured a prison sentence against a former office manager involved in a substantial Medicaid fraud scheme tied to a Montgomery County home care provider. Barbara Thomas, 46, was sentenced in Montgomery County Court to 9 to 23 months in prison followed by four years of probation after pleading guilty
Pennsylvania Medicaid Fraud: Office Manager Sentenced in $1.76M Scheme Read More »
The healthcare industry has long been the primary target for False Claims Act (FCA) enforcement, with no other sector in close second place.Over the past year, the federal government has unveiled several new or revamped whistleblower programs, most notably the Department of Justice’s antitrust program, which we have previously written about. However, despite the expanded
The Healthcare Industry Remains the Largest Target for False Claims Act Enforcement Read More »
From the earliest days of the False Claims Act (FCA), the federal government has understood that providing financial incentives to whistleblowers is one of the best ways to encourage private citizens to come forward and file qui tam actions. That is why the FCA expressly provides that in the event of a successful case, the
Factors Determining the Relator’s Share of an FCA Recovery Read More »
Preparing a successful qui tam case comes down to evidence. It is all well and good to tell the government where and how to find supporting documents and records, but there is no substitute for providing that evidence to the government on the front end. Recorded conversations can be some of the most effective and
A recent GAO report has cast a spotlight on persistent fraud vulnerabilities within the Federal Employees Health Benefits (FEHB) program, revealing that the Office of Personnel Management (OPM) has yet to take decisive action to protect that program. This stands in stark contrast to the comparatively robust fraud prevention mechanisms in place for other federal
Whistleblowers Needed: FEHB Fraud Oversight Lags Behind Medicare and Medicaid Read More »
As a simple matter of dollars and cents, it is hard to overstate just how big a problem healthcare fraud is. A good reminder of this came earlier this summer, when the Department of Justice (DOJ) announced numerous criminal indictments in “Operation Gold Rush,” targeting a multinational, multi-billion-dollar health care fraud scheme. The Department of
Operation Gold Rush – A Reminder of Just How Much Money Is Lost from Healthcare Fraud Read More »
The Department of Justice’s Antitrust Division has launched its first-ever Whistleblower Rewards Program, working in tandem with the U.S. Postal Service (USPS) and Postal Inspection Service. Under this new program, individuals who provide credible information leading to successful antitrust prosecutions are eligible for awards between 15% and 30% of any criminal fines the government recovers,
Department of Justice Announces First-of-Its-Kind Antitrust Whistleblower Program Read More »
This is the sixth and final entry in a six-part series on the process and practical realities of being a whistleblower and exposing fraud against the government.
So You Want to Blow the Whistle (Part 6): My Case Is On File. Now What? Read More »
This is the fifth entry in a six-part series on the process and practical realities of being a whistleblower and exposing fraud against the government.
