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Kaiser Foundation Health Plan to Settle False Claims Act Allegations

Oakland, CA based Kaiser Foundation Health Plan has agreed to pay $6.3 million to settle allegations that it submitted false Medicare Advantage patient diagnoses in order to receive inflated payments from Medicare.

Under the Medicare Advantage program, Medicare pays private insurers based on the cost of providing care for all recipients enrolled in their plans. Generally, patients with worse or more numerous diagnoses result in larger payments while healthier patients result in smaller payments.

The suit was brought by a former employee of Kaiser Health foundation. She will receive $1.5 million for her role in the settlement.

Read the full press release here: https://www.justice.gov/opa/pr/medicare-advantage-provider-pay-63-million-settle-false-claims-act-allegations

Peer Review Doesn’t Apply in False Claims Act Suit

Massachusetts General Hospital could not assert the medical peer review privilege to block production of documents sought by a whistleblower in her False Claims Act suit over the hospital’s alleged double and triple booking of surgeries, a U.S. magistrate judge has ruled.

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During discovery, Wollman (relator) moved to compel production of medical peer review records and communications. In response, MGH asserted the peer review privilege, which keeps reports and records of medical peer review committees confidential.

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Wollman’s attorney, Reuben A. Guttman of Washington, D.C., hailed the decision as an important ruling under the False Claims Act and said it was consistent with black-letter law.

“The case cries out for transparency,” Guttman added. “It is about cheating the government through the gross compromise of patient relationships and critical health care standards.”

Source: Massachusetts Lawyers Weekly. Read full article here.

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Medtronic USA Inc. Agrees to $9.2 Million Settlement

Minnesota-based Medtronic USA Inc. has agreed to pay $9.2 million to resolve allegations that it violated the anti-kickback provision of the False Claims Act. The company was accused of illegally paying Wilson Asfora, M.D., a South Dakota neurosurgeon, to induce use of it’s SynchroMed II infusion pumps, which are implantable drug delivery devices. For a period of nine years, the lawsuit contends, Medtronic’s kickbacks were paid in the form of sponsoring hundreds of social gatherings hosted by Asfora at a restaurant which it knew he owned. Medtronic’s settlement also resolves it’s liability for failing to disclose that it sponsored events for Asfora, which qualifies as a transfer of value to a physician and therefore violates the CMS Open Payments Program.

Read more here: https://www.justice.gov/opa/pr/medtronic-pay-over-92-million-settle-allegations-improper-payments-south-dakota-neurosurgeon

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DOJ Announces $24.9 million Settlement with Guild Mortgage Company

San Diego based Guild Mortgage Company, participant in the Federal Housing Administration insurance program, has agreed to pay $24.9 million to resolve allegations that it caused the submission of false claims for recovery of defaulted home loans. Guild was accused of violating the False Claims Act by knowingly approving ineligible home ownership loans then recovering the insurance payments when the loans defaulted. Prior to underwriting a federally insured loan, mortgage companies participating in the FHA mortgage insurance program must review it for compliance with FHA rules and loan quality control.

The suit was brought under the qui tam provision of the False Claims Act. The whistleblower, former head of quality control at Guild, will receive nearly $5 million for his role in the case.

Read more here: https://www.justice.gov/opa/pr/guild-mortgage-company-pay-249-million-resolve-allegations-it-knowingly-caused-false-claims

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Geissler v. Sterling

District of South Carolina.

GBB lawyers contributed to this class action lawsuit, filed against the Department of Correction, alleging that South Carolina prisoners recieved inadequate testing and treatment for hepatitis C (HCV). The complaint accuses DOC director Bryan Sterling of “deliberate indifference” by neglecting to implement regular testing and effective treatment protocols, because it would have incurred a significant cost to the DOC budget. The original plaintiffs, three inmates in SC state prison, argued that the DOC had violated their 8th Amendment Rights by failing to provide proper treatment. Further, the South Carolina DOC written policy states that HCV is not tested for “except under limited circumstances,” which runs contrary to DCD guidelines.

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