Posts Tagged ‘fraud’

Investigative Report on Medical Fraud Profiles James Hoyer Whistleblower Case

A powerful investigative report appearing on several Florida TV stations is exposing the alarming problem of medical equipment fraud, which costs taxpayers billions of dollars every year. (Watch the report above.)

James Hoyer clients Codi Fletcher & Daniel Yarbrough interviewed for investigative report (Photo courtesy: WPTV)

Two whistleblowers represented by the James Hoyer law firm were interviewed and shared their stories to help expose the problem.

Both former employees of AM-Med Medical Supplies in Florida, they explained how patients were endlessly harassed to buy equipment they didn’t want and then the government was billed for it.

Attorney Jesse Hoyer interviewed by Scripps Investigative Reporter Katie LaGrone. (Photo courtesy: WPTV)

 

James Hoyer partner Jesse Hoyer also talked with Scripps Investigative Reporter Katie LaGrone to explain how this whistleblower case is shining a light on this troubling issue.  The suit reveals that supplies were even sent to dead people with taxpayers picking up the tab.

LaGrone presents a compelling report on how this nationwide problem takes advantage of patients and taxpayers.

Click here to read the full report on the website for WPTV TV in Ft. Myers.  Or click here to read the full report on the website for Fox4 in Tallahassee. And click here to read the full report on ABC Action News in Tampa.

 

 

Attorney General Nominee Pledges Support to Fight Fraud using False Claims Act

Alabama Senator Jeff Sessions is being questioned this week at confirmation hearings on his nomination for U.S. Attorney General by President-elect Donald Trump.  On Tuesday, Senator Sessions pledged his support to fighting fraud against the government and his support of the False Claims Act as a means to do so. Read More…

 

Expert: Fraud Leads to Poor Quality Healthcare

Photo by HFMA.org

Photo by HFMA.org

Harvard professor and healthcare expert Atul Gawande recently noted that the unnecessary medical care endangers patients and robs the taxpayers.  In a recent article published in The New Yorker, Gawande cited fraud as a significant contributor to what leading researchers describe as “low-value care.”  Gawande, a general surgeon, notes that ‘[d]octors get paid for doing more, not less,” and that a huge percentage of Medicare patients receive unnecessary and wasteful care.  You can read Dr. Gawande’s full article on The New Yorker’s website.


Excerpted in Part:

I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer.

To my surprise, it appeared that seven of those eight had received unnecessary care. Two of the patients had been given high-cost diagnostic tests of no value. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.)

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical “toxicities” of inappropriate care—including reduced spending on food, clothing, education, and shelter. Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.

 

 

James Hoyer Lead Investigator Explains Florida Fraud for the Tampa Bay Times

Al Scuderi- Lead Investigator James Hoyer Law FirmJames Hoyer’s lead investigator Al Scudieri was recently interviewed for an article about the abundance of fraud complaints in Florida by Robert Trigaux of the Tampa Bay Times.

Al’s theory as to why fraud is so prevalent in Florida is that:

Florida’s not only the third most populated, its population is different… I think we have a more affluent, elderly population. With a heavier concentration of those demographics in this state, they are the most susceptible…They are the ones bad people want to target.

You can read the full article here.

 

 

Health-Care False Claims Cases Reap $18.3 Billion, Report Shows

Whistleblower Award

Health-Care False Claims Cases Reap $18.3 Billion, Report Says

Stack Of CashFederal and state governments recovered $18.3 billion between 2008 and 2012 from lawsuits and criminal cases claiming health-care companies overbilled, according to an advocacy group that encourages whistle-blowers.

Taxpayers Against Fraud, a Washington-based group, released a study showing total health-care recoveries, excluding whistleblower payments, rose to $5.8 billion last year from $1.5 billion in 2008. Those totals include criminal fines and state false claims recoveries, two figures not normally tallied.

Still, recoveries are a small fraction of the $2.8 trillion the U.S. spends annually on health care, or 17.8 percent of the gross domestic product, according to the World Health Organization. Senator Charles Grassley, an Iowa Republican who sponsored a 1986 amendment that propelled the U.S. law forward, said the Justice Department should do more to deter companies than collect payments.

“Right now, it’s a cost of doing business,” Grassley said in an interview. “When it’s a cost of doing business, behavior isn’t going to change and criminal prosecution needs to be pursued. When you jail somebody, it makes a bigger point than any fine you’re going to get.”

The health-care recoveries involve dozens of companies, including Pfizer Inc. (PFE:US), the world’s biggest drugmaker; GlaxoSmithKline Plc (GSK), the biggest U.K. drugmaker; Merck & Co. (MRK:US), the second-biggest U.S. drugmaker by sales; and McKesson Corp. (MCK:US), the largest U.S. pharmaceutical distributor. Many of the settlements involve corporate integrity agreements pledging compliance with the law.

29 States

Most cases were filed under the federal False Claims Act, the law that lets citizens sue on behalf of the government and share in any recovery. Twenty-nine states have similar laws. Most of the recoveries by the U.S. between 1987 and 2012 were in health-care cases, where the government recovered $24.1 billion, according to Justice Department statistics.

Between 2008 and 2012, the civil U.S. recoveries amounted to $9.4 billion, according to the Justice Department. The TAF report shows that criminal fines associated with false claims recoveries over the same period were $4.5 billion, while state recoveries were $4.4 billion. Taken together, the civil, criminal and state false claims recoveries account for the five-year total of $18.3 billion.

Whistle-Blowers

Whistleblowers over that period collected $1.4 billion beyond the $9.4 billion paid to the U.S. The law allows whistle-blowers to recover between 15 and 30 percent. Not every case settled by the U.S. was initiated by whistle-blowers.

The TAF report argues that the federal government recovers about 20 times more than it spends on investigations and prosecutions of health-care fraud cases.

Whistleblowing is increasing in other sectors, including finance and taxation. With programs in place at the Securities and Exchange Commission, the Internal Revenue Service, and the U.S. Commodity Futures Trading Commission, many more cases are coming, according to Patrick Burns, co-executive director of TAF.

“We are on the edge of a new era of incentivized integrity programs,” said Burns. “It takes a long time to investigate, negotiate and litigate these cases, but I think we will see billions recovered under these programs in the years ahead.”

If you believe you have information regarding fraud against the government and are considering bringing a False Claims Act case, please contact James Hoyer for an evaluation of your claims. Click here for more information about the firm, and to submit your information electronically, or you may contact our office at 813-397-2300.

If you believe you have information regarding fraud against the government and are considering bringing a False Claims Act case, please contact James Hoyer for an evaluation of your claims.  Click here for more information about the firm and to submit your information electronically, or you may contact our office at 813-397-2300. – See more at: http://www.jameshoyer.com/supreme-court-denies-cert-in-allison-engine-retroactivity-case/#sthash.PgY15ire.dpuf