JeffNewman's Blog

CARDIOLOGIST WHISTLEBLOWER FILES SUIT CLAIM UNECESSARY ANGIOPLASTY

jeffreynewmanlaw — Mon, 23 Jan 2012 14:09:02 +0000

A cardiologist, previously affiliated with Hamot medical center has filed a whistleblower action saying that a group of Erie Pa doctors defrauded Medicare by performing uncessary and costly surgeries involving heart stents. This case is one of many involving angioplasty surgery as the medical community itself is examining the procedures involving insertion of a stent, which is a tiny mesh tube meant to keep an artery open to improve blood flow. A study published in the Journal of the American Medical Association in July concluded that 12 percent of the angioplasty procedures nationwide were inappropriate. The whistleblower Tullion Emanuele M.D. is actually claiming that one patient died after undergoing a heart catheterization he did not need. Another patient, he said, died from complications of an unecessary bypass surgery. The lawsuit also alleged kickbacks in exchange for patient referrals and that the average cost of the angioplasty costs about $20,000. The doctor is pursuing the case under the False Claims Act which allows private citizens to sue on behalf of the government over allegations of fraud and mis-billing of the government. The whistleblowers are entitled to as much as 30% of what the government recovers. Attorney Newman represents whistleblowers.

JOHNSON & JOHNSON SETTLES MEDICAID FRAUD WHISTLEBLOWER SUIT FOR $158 MILLION

jeffreynewmanlaw — Thu, 19 Jan 2012 18:38:17 +0000

Johnson & Johnson has agreed to pay $158 Million to settle a major whistleblower lawsuit alleging that the company for paying kickbacks and for other illegal marketing practices to bosst Resperal, a pill for schizophrenia and bipolar disorder. The lawsuit was originally filed by a former employee of the office of Inspector General in Pennsylvania who said he learned of the actions while investigating similar claims in his home state. Last year a judge in South carolina ruled that the company must pay $327 million after a jur found it guilty of overstating the safety and effectiveness of the same drug. In 2010 a Louisiana jury found the company violated the states Medicaid fraud act and awarded $258 million in damages.

U.S TO REQUIRE MEDICARE/MEDICAID DRUG AND DEVICE COMPANIES TO REPORT MONEY PAID TO DOCTORS

jeffreynewmanlaw — Wed, 18 Jan 2012 20:22:09 +0000

Under a new health care law, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all payments to doctors and the feds will be posting the information on a public web site available to all. More than 1,100 drug, device and medical supply companies will have to file reports. Comsumer advocates including many physician groups say that this will help curb conflicts of interest. Medicare and Medicaid are programs for older Americans, the disabled and the poor and more than $100 billion per year is spent on drugs and devices. The law also requires the drug and device companies to disclose the amount of any ownership or investment interest held by doctors or their immediate family members other than holdings of publicly traded stocks.

OMNICARE HIT WITH NEW WHISTLEBLOWER SUIT FOR INFLATING DRUG PRICES

jeffreynewmanlaw — Tue, 17 Jan 2012 01:43:44 +0000

The nation’s largest nursing home drug provider, Omnicare, which paid nearly $10 million two years ago to settle a whistleblower lawsuit has now been met with a new suit alleging that it wrongfully received millions of dollars annually from Medicare, Medicaid, CHAMPUS and other government health insurance programs. The new complaint came from whistleblower Peter Ordeanu who worked as a pharmacist for Omnicare predecessors Procare and Enloe from 2006-2011. He alleges that Imnicare regularly inflated the amount of money billed for dispensing drugs with a National Drug Code number on the label that was different from the drug dispensed. In one instance for example the company charged over $1,000 for Vancomycin in oral liquid form which cost the company $4.00. The government is seeking treble damages.

HOSPITALS HIRING SALES REPS TO WOO DOCS AND BUMP PROFITS–JUST LIKE BIG PHARMA

jeffreynewmanlaw — Tue, 10 Jan 2012 22:16:09 +0000

The Kaiser Health News is reporting that hospitals are now adopting strategies used by the pharmaceutical industry in selling their drugs, including hiring individuals to make sales calls on physicians in the hope that they will refer more patients to the hospital. The University of Chicago Medical Center is one of a growing number of hospitals hiring former drug and device sales reps to visit doctors offices in order to persuade them to use their services. Instead of leaving samples of prescription drugs, the sales reps reveals the newest information about the hospitals and how they are reducing hospital acquired infections and improving patient satisfaction scores. In some cases, the representatives can help the physicians obtain better times in operating rooms and also carry back messages to the hospital such as a request for a new medical device to be available in surgery. Tenet Healthcare Corporation the nation’s third largest for profit chain has soubled its sales force in the last two years. It now has 152 physician liasons most in California Texas and Florida.

ACTAVIS TO PAY $118.6 MILLION TO END DRUG PRICING WHISTLEBLOWER CLAIM

jeffreynewmanlaw — Thu, 05 Jan 2012 15:50:20 +0000

In a settlement filed on Dec 29 in the Federal District Court in Boston, Actavis has agreed to pay the government over $118 million for falsely reporting inflated prices of drugs and falsely collecting higher reimbursement rates from Medicare. The whistleblower in this case was a group of individuals who own and manage a company called Ven-A-Care of the Florida Keys, a specialty pharmacy which prosecuted the claims civilly. Ven-A-Care has settled more than 20 lawsuits since 2000 which allowed the state and federal governments to collect about $3 billion. Ven-A-Care collected about $400 million in whistleblower fees suring that period. The case in Boston is In re Pharmaceutical Average Wholesale Pricing Litigation MDL No 1456 U.S. District Court of Massachusetts.

U.S. JOINS WHISTLEBLOWER SUIT SAYING ASERACARE HOSPICE MISBILLED MILLIONS TO MEDICARE

jeffreynewmanlaw — Wed, 04 Jan 2012 16:45:28 +0000

The United States has intervened and filed a complaint in a whistleblower suit against AseraCare Hospice for mis-billing Medicare millions of dollars for treatment of individuals are were not terminally ill. Golden Gate Ancillary LLC d/b/a AseraCare is a for profit business with 65 hospice providers in 19 states. An individual is entitled to hospice care paid for by Medicare only when they are terminally ill. AseraCare entered individuals into its hospicecare program, according to the complaint, who were not diagnosed as being terminally ill. In recent months there have been several similar suits against other hospicecare companies who are servicing individuals who are not terminally ill and mis-billing millions to Medicare. The whistleblower suit was filed by Dawn Richardson and Marsha Brown, former employees of AseraCare Hospice and they will be entitled to obtain a reward of between 15-25% of what the government recovers.

2011 in review

jeffreynewmanlaw — Mon, 02 Jan 2012 13:34:14 +0000

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s an excerpt:

A New York City subway train holds 1,200 people. This blog was viewed about 7,800 times in 2011. If it were a NYC subway train, it would take about 7 trips to carry that many people.

Click here to see the complete report.

GE HEALTHCARE PAYS $30 MILLION TO SETTLE HEALTHCARE FRAUD WHISTLEBLOWER CASE

jeffreynewmanlaw — Wed, 28 Dec 2011 20:49:32 +0000

GE Healthcare, a global provider of medical technologies and pharmaceuticals has agreed to pay $30 million to settle a False Claims Act whistleblower case alleging the company provided false information in connection with its distribution of the radiopharmaceutical agent Myoview to the federal Medicare program. The drug is used by health care providers in cardiology to perform nuclear stress tests. The whistleblowers said that the company orchestrated a scheme in which Myoview was improperly diluted in order to maximize trhe number of doses available per vial. This lead to an increased number of patient-ready doses and inflated Medicare reimbursements. Under the settlement, the whistleblowers will receive $5,100,000 as his reward for blowing the whislte. Costs and attorneys fees will also be paid.

SKILLED NURSING CARE MEDICARE FRAUD

jeffreynewmanlaw — Thu, 22 Dec 2011 20:24:53 +0000

Under an extension of Medicare Part A coverage, post-hospital skilled nursing care exists for qualifying patients. To qualify, a patient otherwise appropriate for Medicare must show a qualifying hospital stay of three or more days within 30 days before entering the skilled nursing facility and a physician mus order procedures for the patient that are appropriate only at a skilled nursing facility (SNF). The physician must certify that the patient’s condition should improve. There are several kinds of fraud which have been uncovered by Congressional investigators and which are being reported by whistleblowers working for rehab companies including:
*Aggressively recruiting hospital patients who are not appropriate for skilled care;
*”skilling” patients who do not require and cannot benefit from physical, occupational or speech therapy;
*creating improper relationships between SNF’s and hospices where patients are shuffled between benefits to increase billing without regard to the patient’s well being;
*Improperly extdning patient stays beyond medical need;
*Paying illegal kickbacks between SNF’s and hospices for cross referrals, especially where hospice nurses provide free services to SNF patients.