Tuesday, October 31, 2006

HMO Amerigroup found guilty of shunning High-Risk Patients

An HMO hired by the government to provide medical coverage for the poor in Illinois will have to pay damages of $144 million for discriminating against pregnant women and other potentially high-risk patients, a federal jury in Chicago decided Monday.

After two days of deliberations, the jury found that Amerigroup Corp. and subsidiary Amerigroup Illinois sought to increase their profits on Medicaid dollars paid into their plans by signing up mostly healthy clients and intentionally avoiding those who had health issues.

The original award was $48 million, but under the federal False Claims Act it will be tripled to $144 million in what amounts to a major victory for federal and state prosecutors. Prosecutors said they also will seek almost $200 million more in penalties from the Virginia Beach, Va.-based company because it filed more than 18,000 false claims with the state.

Click the following link to read the full story on Amerigroup’s Medicaid fraud damages.

Monday, October 30, 2006

Oracle to pay $98.5 Million to settle Charges Against PeopleSoft

Oracle Corp. has agreed to pay the U.S. government $98.5 million to settle allegations that PeopleSoft Inc., which it acquired last year, overcharged federal buyers under the General Services Administration’s multiple-award schedule program.

When Oracle acquired PeopleSoft Inc. (Pleasanton, Ca) for $10.3 billion in January 2005, it inherited its liability under the GSA contract. Former PeopleSoft employee James Hicks told government officials that PeopleSoft did not give federal buyers discounts for purchases of multiple goods and services that commercial customers received. The false pricing is alleged to have taken place over a period of eight and one-half years. The settlement is the largest payment ever obtained by the United States in a civil settlement under the False Claims Act involving the GSA’s multiple-award schedule program.

Click the following link to read the full false claims settlement story.

Illinois Company agrees to pay $4.2 Million to settle Kickback Charges

An Illinois transportation firm has agreed to pay $4.2 million to settle U.S. Justice Department accusations that it had deliberately overcharged Norfolk (Va) Naval Shipyard for delivering cargo. And the original whistleblower—who runs a competing freight forwarding firm in Newport News—is sharing in the winnings.

AIT Worldwide Logistics, of Itasca, Ill., had been accused of scheming with its agent in the Hampton Roads area and a transportation officer at Norfolk Naval Shipyard to bilk the government in exchange for giving kickbacks to the transportation officer. Paul Watkins, who runs the Oyster Point division of Target Logistics Services—a Baltimore-based company that competes with AIT for freight forwarding contracts—was the original whistleblower, gathering evidence of the scheme three years ago and reporting it to the Naval Criminal Investigative Service. Under the terms of the federal whistleblower act, Watkins and his lawyer will split 18 percent of the amount of the Justice Department winnings.

Click the following link to read the full story of the whistleblower settlement in the Hampton Roads (Va) Daily Press.

Tuesday, October 24, 2006

Atlanta Hospital settles Medicare Lawsuit for $5.7 Million

Atlanta’s Northside Hospital will pay $5.7 million and two physician-owned businesses will pay $650,000 to settle claims raised in a whistleblower lawsuit that they submitted claims to the Medicare program that were tainted by improper financial and referral relationships.

The whistleblower suit was filed in February 2004 by two former employees of Blood Marrow Transplant Group of Georgia (BMTGA), one of the doctor-owned entities: Cheryl Burns, a former CEO, and Janine Slaughter, a former billing/office manager. Burns and Slaughter filed their complaint under the False Claims Act, which allows the United States to recover triple damages and civil penalties for false claims that are knowingly submitted to government programs.

Click the following link to read a full account of the false claims settlement.

Monday, October 23, 2006

California Medicare Fraud Case settled for $33.8 Million

A woman who owned and operated two home health agencies in California has paid the federal government $33.8 million in one of the largest Medicare fraud cases in state history, a federal prosecutor said.

Lourdes “Lulu” Perez, owner of Tri-Regional Home Health Care in San Dimas and Provident Home Health Services in Eagle Rock, over-billed Medicare by about $40 million between October 2002 and September 2003 through a network of paid recruiters and falsified documents, according to Consuelo S. Woodhead, an assistant U.S. attorney investigating health care fraud.

“It’s a huge amount for what would be considered as a mom-and-pop operation that could be opened with very little capital,” she said told the San Gabriel Valley Tribune.

Perez, who now lives in San Diego, pleaded guilty in October 2004 to five counts of health-care fraud and three counts of subscribing false tax returns, according to a settlement unsealed last month. She is scheduled to be sentenced in U.S. District Court in Los Angeles and faces up to 59 years in federal prison.

Click the following link to read the complete story on the record Medicaid fraud case.

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