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Veterans care, Seniors, Hospitals and Pharmacies

VA Health

Many of the health care frauds described on our website involve not only Medicare and Medicaid, but also the health care programs of the United States Department of Veterans Affairs and impact veterans.

The Department of Justice is very protective of programs that help American veterans.

As one United States Attorney said, “The VA provides invaluable assistance to those who have sacrificed on our behalf.  It is vital that those who administer programs for the VA be held accountable to do so with the utmost care and integrity.”

One company that was paid by the VA and the taxpayers to administer certain portions of the VA Patient-Centered Community Care (PC3) and Veterans Choice Programs by coordinating medical appointments and making payments to health care providers paid over $179 MILLION for double-billing the Government for these services.

The same company was a repeat player, having years earlier paid a $10 MILLION False Claims Act settlement.  In the prior case, the company failed to give TRICARE (the program for active military families) the benefit of negotiated discounts with service providers.

Individuals who reported the earlier fraud to the Department of Justice received $1.7 MILLION for their assistance.

If you are aware of old, new, or evolving fraud schemes involving VA health programs, the Department of Justice may be very interested in learning more about the information you have.  You may also be entitled to a financial reward.  Tell us about the information you have and we will provide you a free consultation.

Seniors and Elder Abuse

The Department of Justice has also been aggressive about using the False Claims Act to combat schemes designed to take advantage of seniors and the elderly by providing them poor health care or no care at all, and elder abuse.

In addition to substandard care, fraud schemes to report include skilled nursing facility chains and rehabilitation contractors knowingly providing or billing for medically unnecessary rehabilitation therapy services that were guided by financial considerations instead of the needs of patients.

One pharmaceutical company paid over $95 MILLION to resolve allegations that it paid kickbacks and engaged in false and misleading marketing of one of its drugs that was approved by the FDA for the treatment of a disorder which is characterized by involuntary, sudden, and frequent episodes of laughing or crying, and occurs secondary to neurologic disease or brain injury.

The alleged purpose of the kickbacks was to induce providers in long term care facilities, including nursing homes, to prescribe the drug for behaviors commonly associated with dementia patients, which was not an FDA-approved use.

The Department of Justice pointed out that over-medicating nursing homes residents is a well-documented problem, which can lead to a host of issues, including unnecessary side effects and over-sedation of patients.

Three former employees of the pharmaceutical company reported the fraud scheme to the Department of Justice, and they received more than $17 MILLION as a reward.

A nursing home chain paid more than $18 MILLION for billing the Medicare and Medicaid programs for grossly substandard nursing home services, including the failure to administer medications, meet basic nutrition and hygiene requirements, and to provide standard infection control, and the unnecessary use of physical restraints on patients.

If you are aware of old, new, or evolving fraud schemes involving seniors or elderly individuals, including elder abuse, the Department of Justice may be very interested in learning more about the information you have.  You may also be entitled to a financial reward. Tell us about the information you have. We will provide you a free consultation.

Cost Reporting

Hospitals and certain health care organizations are required to submit “cost reports” to Medicare. These reports are used to calculate reimbursement rates under Medicare.  Therefore, if a hospital manipulates its cost reports or falsifies the data in the reports, it can fraudulently obtain more money than it is entitled to.

Another fraud scheme that the Department of Justice has investigated is where a hospital submits cost reports to Medicare for compensation paid to executives who did not perform reimbursable work for the hospital.  Both of these schemes are violations of the False Claims Act.

One of these schemes even resulted in a jury verdict for more than $30 MILLION, including penalties, against a hospital, a management company, and executives.

The individual who brought the fraud scheme to the attention of the Government was entitled to a share of the jury’s verdict.

If you are aware of old, new, or evolving fraud schemes involving cost report fraud, the Department of Justice may be very interested in learning more about the information you have.  You may also be entitled to a financial reward. Tell us about the information you have. We will provide you a free consultation.

Compounding Pharmacy

The Department of Justice has pursued many cases against compound pharmacies for knowingly inflating prices and for paying unlawful kickbacks and sometimes for both.  DOJ is always interested in hearing from individuals with knowledge about new and old fraud schemes involving compounding pharmacies. One case that individuals brought to the attention of the Department of Justice involved allegations that a pharma company knowingly inflated average wholesale prices (AWPs) for active drug ingredients used in compound pharmacies.  Further, the company allegedly promoted these high AWPs to induce pharmacies to purchase its ingredients.  The pharma company paid over $22 MILLION to resolve the case and the individuals who reported the fraud were awarded $3.7 MILLION.

In another case, an individual reported to the Department of Justice that a compounding pharmacy allegedly paid kickbacks to outsiders who acted as marketers.  The marketers targeted military members and their families to get them prescriptions for compounded creams and vitamins and TRICARE paid for those prescriptions at higher than necessary prices.

Here the Department of Justice recovered over $21 MILLION and the individuals who reported the fraud received a share of the settlement.

Once again, this kind of conduct is fraud and cheats the taxpayers.

If you are aware of old, new, or evolving fraud schemes involving compounding pharmacies, the Department of Justice may be very interested in learning more about the information you have.  You may also be entitled to a financial reward. Tell us about the information you have. We will provide you a free consultation.

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