In a critical development against healthcare fraud, several Southern California-based clinics, a laboratory, and their owners have agreed to pay $10 million to settle allegations of submitting false claims to Medicare and Medi-Cal. The settlement in this case demonstrates the government’s commitment to protecting the integrity of federal healthcare programs and addressing violations involving kickbacks...
The National Highway Traffic Safety Administration (NHTSA) recently finalized its long-anticipated whistleblower program rule, an important step toward ensuring accountability and transparency within the automotive industry. Issued on December 5, 2024, the final rule implements the Motor Vehicle Safety Whistleblower Act, a law enacted in 2015 as part of the Fixing America’s Surface Transportation (FAST)...
The recent move by Pennsylvania pharmacies to consolidate antitrust claims against GoodRx in the District of Rhode Island shines a light on the often murky and generally contentious relationships between pharmacies, pharmacy benefit managers (PBMs), and prescription discount platforms. For whistleblowers who know anything about the often-complex practices of PBMs, this case brings forth the...
The U.S. Securities and Exchange Commission recently released its Annual Report to Congress for Fiscal Year 2024, highlighting the significant achievements of its Whistleblower Program. The program is—and has been—a significant component in the protection of investors and maintaining market integrity through incentivizing reporting of possible violations of the securities laws by individuals. Top 5...
2024 witnessed some of the most notable class action lawsuits in the United States, ranging from accusations of antitrust violations to data breaches. The suits were brought not only in pursuit of monetary redress but also to ensure corporate accountability and consumer protection. 1. Blue Cross Blue Shield’s Antitrust Settlement A US judge has granted...
UCHealth, a major health care provider in Colorado, has agreed to pay $23 million to resolve allegations of fraudulent billing in its emergency departments. The settlement addresses claims that UCHealth falsely billed Medicare and Medicaid for more costly levels of care than were necessary, a practice known as “upcoding.” The allegations, brought to light through...
Paragon Systems, Inc., a security contractor for federal agencies, has agreed to pay $52 million to settle allegations of violating the False Claims Act (FCA). According to the U.S. Department of Justice (DOJ), Paragon allegedly submitted fraudulent claims to the U.S. government for security services that were not provided as promised. This case underscores the...
The healthcare industry continues to see enforcement of strict regulations designed to prevent fraud, especially when it comes to the misuse of government healthcare programs like Medicare, Medicaid, and TRICARE. In one significant case, Acadia Healthcare Company Inc., a Delaware corporation with its principal place of business in Franklin, Tennessee, agreed to pay $19.85 million...
In a significant case highlighting the risks of medical billing fraud, Precision Toxicology, a California-based clinical laboratory, has agreed to pay $27 million to resolve allegations of fraudulent billing practices. The allegations, as detailed by the Department of Justice (DOJ), center around the submission of false claims to Medicare, resulting from unnecessary drug testing and...
The U.S. Securities and Exchange Commission (SEC) recently announced an extraordinary milestone in its efforts to encourage whistleblowers and uphold market integrity. In a groundbreaking decision, the SEC awarded over $98 million to two whistleblowers whose tips and subsequent cooperation were instrumental in leading to significant enforcement actions against violators of federal securities laws. This...