Tag Archives: qui tam
Medicare Advantage Audit Shows $197 Million in Over-Payments
In April 2021, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) released a report regarding a Medicare Advantage Compliance Audit of one of the country’s major Medicare Advantage Organizations, Humana, Inc. The audit covered only one year, 2015, and one particular contract. The audit selected a random sampling of 200… Read More »
Government Issues Preliminary Report on Coronavirus Relief Fraud
On September 1, 2020, the Congressional Select Subcommittee on the Coronavirus Crisis released a preliminary analysis of potential waste, fraud and abuse issues in the Paycheck Protection Program (PPP), which was implemented as part of the massive Coronavirus Aid, Relief and Economic Security (CARES) Act. Under the PPP Program, the federal government provided more… Read More »
CARES Act Fraud – the Paycheck Protection Program
On March 27, 2020, Congress passed the Coronavirus Aid, Relief and Economic Security Act of 2020, also known as the CARES Act. In total, the CARES Act will provide approximately $2 trillion in economic aid in the wake of the Coronavirus (COVID19). This is the largest economic aid package in the history of the… Read More »
What is a Reverse False Claim?
Most qui tam whistleblower lawsuits under the False Claims Act involve a Defendant who has made a fraudulent “claim” for money upon the government. For example, when a hospital sends a bill to Medicare for a medical procedure that was never performed, the hospital has made a “claim” for money upon the government. If… Read More »
What is Risk Adjustment Fraud?
In 1997, Congress decided that traditional Medicare was way too expensive. At the time, Medicare operated under a traditional fee-for-service model. Under this model, if a doctor delivered services to Mrs. Jones, the government paid the doctor a fee for his or her services, i.e, fee-for-services. Congress thought it found a better way. Rather… Read More »
