Showing posts with label fraud. Show all posts
Showing posts with label fraud. Show all posts

Thursday, April 27, 2017

Partners, Brigham pay $10M to settle research fraud probe


Partners, Brigham pay $10M to settle research fraud probe

Partners Healthcare and Brigham and Women’s have agreed to pay $10 million to settle allegations by the federal government that a group of former stem cell researchers at the hospital falsified data to win grant funding from the NIH.

The U.S. Attorney’s Office in Boston announced the settlement, which stems from grant applications submitted by a stem cell research lab run by former Harvard Medical School professor Piero Anversa.

According to the government, Anversa and two other researchers, Annarosa Leri and Jan Kajstura, used “manipulated and falsified information” to obtain funding to study whether stem cells can repair cardiovascular damage. The data was published in a 2012 issue of the journal Circulation, but the study was later withdrawn amid allegations that it had been partially fabricated.

Anversa and Leri sued Brigham in 2014, saying the hospital's investigation into their alleged conduct was flawed and marred by conflicts of interest. A judge dismissed that case in 2015.

On Thursday, prosecutors credited Brigham with voluntarily disclosing the possible fraud to the government, and noted that the scientists are no longer affiliated with the hospital.

“Individuals and institutions that receive research funding from NIH have an obligation to conduct their research honestly and not to alter results to conform with unproven hypotheses,” Acting U.S. Attorney William Weinreb said in a statement. “Medical research fraud not only wastes scarce government resources but also undermines the scientific process and the search for better treatments for serious diseases.”

In a statement, a Brigham spokesperson said the hospital ceased drawing funds implicated in the alleged fraud when the claims came to light, and also closed the lab.

"BWH is committed to ensuring that research conducted at the institution is done under the most rigorous scientific standards, and has made significant enhancements to research integrity compliance protocols as a result of this event," the spokesperson said.

Monday, July 11, 2016

Will Kaiser Foundation Health Plan lawsuit against its own investigator reveal more than Kaiser would like?

I'm guessing Quinn told Kaiser what they wanted to hear so they didn't ask questions. I wonder how many Kaiser members were denied health care on the basis of this man's information? How much money did he save Kaiser? I imagine that what Quinn charged Kaiser was a small fraction of the large amount of money he helped Kaiser avoid paying. Will Kaiser reopen those cases and give back to members all such amounts?

Kaiser Foundation Health Plan is not a subsidiary. It's the heart and soul of Kaiser Permanente. It makes about 8 billion tax-free dollars a year. Denying care is a major part of its business plan.
OAKLAND, Calif. (AP) — A subsidiary of health care giant Kaiser Permanente has filed a lawsuit in California accusing an employee responsible for investigating insurance fraud claims of embezzling $7 million, a newspaper reported.

The suit by Kaiser Foundation Health Plan accuses Michael Albert Quinn of submitting invoices for investigative services that were not performed or were not justified over a 16-year span after he joined the company in 1998, the San Francisco Chronicle reported (http://bit.ly/29K2QoA) on Sunday.

Quinn, 45, was responsible for hiring investigators to conduct surveillance on people who were suspected of filing fraudulent claims, He was authorized to approve charges up to $50,000.
The newspaper said Quinn was fired in 2014. Kaiser filed the lawsuit last year...

See more HERE.

Friday, April 25, 2014

Kaiser Permanente San Diego CFO Lynnette Seid personally created a hoax CD of X-ray images

UPDATE APRIL 30, 2014:

CLICK HERE for a transcript of my bizarre adventures in the Kaiser Radiology Records Department in April 2014.

UPDATE APRIL 28, 2014:

I went to Kaiser today to get medical records that I thought might be interesting. I was not disappointed. I discovered that the last doctor I visited at Kaiser wrote this:

When asked how I could help her, [Maura Larkins] states that "really I just wanted to meet you because when I asked Dr. X for a transfer to another doctor, [Dr. X] said anyone except Dr. Z". Patient felt that...I would be honest and maybe go against what my supervisor's might want me to do. Discussed with the patient that this wasn't the case at all...


Is that cute or what? I don't think the doctor who wrote this meant to be quite so truthful about her inability to give an honest second opinion.

ORIGINAL POST ABOUT KAISER CONCEALING TEST RESULTS:


Lynette Seid, CFO and chief administrator
for San Diego Kaiser medical records

See also: Is Kaiser Permanente violating the California Business and Professions Code with false advertising about digitized x-rays?

Lynette Seid is not only Kaiser Permanente San Diego Area's Chief Financial Officer. She's also the chief administrator in charge of medical records.

I asked for a CD of my digital VUCG X-ray images to take to an out-of-plan doctor, and in response, Lynette Seid created a CD with the following X-ray images.

It pretends to be a set of 13 images, but it actually consists of only 7 distinct images.

Four of the images appear twice, labeled with different numbers, but with the exact same time stamp:
#1 is identical to #4;
#2 is identical to #3,
#7 is identical to #9, and
#8 is identical #12.

One image appears three times!
(#10, #11 and #13 are identical).

Some of the copies have labels added (“scout,” “voiding,” and “post-void”), but the time stamped on each image identifies it precisely.

Image #6 is of particular interest; it is the one new image that Kaiser was willing to produce for an out-of-plan doctor.

See the 13 images--or rather, 7 images--here.

Nice work, Lynette! A particularly nice touch was the high-tech CD Lynetter sent me. When I open up the bizarre images, which were first printed out and THEN were scanned, and therefore provide extremely little information, I get a rapid slide show just by moving my cursor across the images. Lynette is pretending that someone might actually be looking at these images for the purpose of discerning information about the X-rays. In fact, the images only provide information about how desperate Kaiser is to conceal information about the X-rays it took.

Lynette Seid (Mulan7224) on Twitter

Life is truly wonderful when you love what you do and you have someone very special to share your life!

[Maura Larkins response: Seriously, Lynette? You love doing stuff like this? Do you get paid a lot to do it? And get lots of appreciation from other extremely highly-paid executives? Perhaps you are blocking out the reality that life isn't truly wonderful when one's medical records are concealed by happy folks like you.]


See all posts re Lynette Seid.

CAN BAD DOCTORS CREATE GOOD KNOWLEDGE?

I believe the answer is YES. Kaiser Permanente, for example, has guidelines that require doctors to sacrifice many patients for the purpose of increasing profits. At the same time, Kaiser collects information that helps it improve the treatment of patients who can be treated without sacrificing profits.

"IN MAY 1988, Dr Robert Pozos, a hypothermia researcher at the University of Minnesota, said he planned to analyse and republish a contemporary 56-page report on infamous Dachau experiments in which almost 300 male prisoners were placed in vats of freezing water.

"The men were observed, measured and analysed, sometimes to the point of death; sometimes they were warmed up again with boiling water. Pozos said he could learn how to treat people with hypothermia better if he understood what went on at Dachau."

This sparked off a passionate debate about the ethics of knowledge. Conferences, seminars, letters and speeches the world over have struggled with what to do about Pozos's approach. Some argued the knowledge should never be used because it was gained immorally. Others asked: "Should we not look at the pyramids because they were built using slave labour?" Eventually, Pozos used the knowledge, but the debate continues. The New England Journal of Medicine, for example, does not publish citations of the work.

Contacts and staff : Information : Nature Reviews Urology
www.nature.com/nrurol/info/info_contacts.html‎
Nature
Chief Editor: Annette Fenner, MBBS, PhD Acting Chief Editor: Sarah Payton, PhD Senior Editor: Melanie ... PhD; David Killock, PhD Cross-Journal Associate Editors: Tim Geach, PhD Editorial Support Manager: ... Clinical Practice & Research.

Saturday, November 2, 2013

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine.

Cheryl Clark
Health Leaders
Nov. 2, 2013

Are you a journalist interested in how doctors practice medicine?

A position is opening up at the company I work for that I would seriously consider applying for. You'd write for hospital providers and physicians about issues in service lines, ethics, physician culture and behavior, relationships with hospital administrators, care appropriateness, medical training and certification, fraud, regulatory changes that are pivoting doctor pay toward outcomes measurement for the whole patient and away from the "pay per visit" and lots of other stuff.

You'd write 50 weekly columns a year and 1,700 (or so) -word articles for our monthly print magazine, HealthLeaders.

Wednesday, May 8, 2013

Wells Fargo will pay $105m to settle OC fraud case regarding Medical Capital Holdings (MedCap)

Wells Fargo will pay $105m to settle OC fraud case
By The Associated Press
May 3, 2013

SANTA ANA, Calif. — Wells Fargo Bank will pay $105 million to settle a lawsuit that held it liable for an Orange County fraud scheme that cost investors as much as $1 billion.

The Orange County Register says the settlement was filed Tuesday.

Wells and Bank of New York Mellon were trustees of investor funds for Tustin-based Medical Capital Holdings. MedCap claimed to sell safe investments but authorities say it gambled on risky ventures such as unlicensed hospitals.

Regulators closed the firm in 2009. Its president pleaded guilty to wire fraud.

The investor lawsuit claimed Wells Fargo and Mellon ignored warning signs that MedCap was a fraud. The banks argued that they followed the terms of their contracts.

Mellon settled its case for $114 million.

Friday, January 25, 2013

Big Pharma consists of very rich "takers" who succeed through fraud, and then get congress to reward them half a billion dollars

Republican Minority Leader Mitch McConnell isn't the only one in the pocket of Big Pharma

Big Pharma buys off the Senate An eleventh hour loophole in the "fiscal cliff" deal confirms our worst suspicions about how Congress operates
BY BILL MOYERS AND MICHAEL WINSHIP
BILLMOYERS.COM
JAN 25, 2013

The inauguration of a president is one of those spectacles of democracy that can make us remember we’re part of something big and enduring. So for a few hours this past Monday the pomp and circumstance inspired us to think that government of, by, and for the people really is just that, despite the predatory threats that stalk it.

But the mood didn’t last. Every now and then, as the cameras panned upward, the Capitol dome towering over the ceremony was a reminder of something the good feeling of the moment couldn’t erase. It’s the journalist’s curse to have a good time spoiled by the reality beyond the pageantry. Just a couple of days before the inaugural festivities, The New York Times published some superb investigative reporting by the team of Eric Lipton and Kevin Sack, and their revelations were hard to forget, even at a time of celebration.

The story told us of a pharmaceutical giant called Amgen and three senators so close to it they might be entries on its balance sheet: Republican Minority Leader Mitch McConnell, Democratic Senator Max Baucus, chair of the Senate Finance Committee, and that powerful committee’s ranking Republican, Orrin Hatch. A trio of perpetrators who treat the United States treasury as if it were a cash-and-carry annex of corporate America.

The Times story described how Amgen got a huge hidden gift from unnamed members of Congress and their staffers. They slipped an eleventh hour loophole into the New Year’s Eve deal that kept the government from going over the fiscal cliff. When the sun rose in the morning, there it was, a richly embroidered loophole for Amgen that will cost taxpayers a cool half a billion dollars.

Amgen is the world’s largest biotechnology firm, a drug maker that sells a variety of medications. The little clause secretly sneaked into the fiscal cliff bill gives the company two more years of relief from Medicare cost controls for certain drugs used by patients who are on kidney dialysis, including a pill called Sensipar, manufactured by Amgen.

The provision didn’t mention Amgen by name, but according to reporters Lipton and Sack, the news that it had been tucked into the fiscal cliff deal “was so welcome, that the company’s chief executive quickly relayed it to investment analysts.” Tipping them off, it would seem, to a jackpot in the making.

Amgen has 74 lobbyists on its team in Washington and lobbied hard for that loophole, currying favor with friends at the White House and on Capitol Hill. The Times reporters traced its “deep financial and political ties” to Baucus, McConnell and Hatch, “who hold heavy sway over Medicare payment policy.”

All three have received hefty campaign donations from the company whose bottom line mysteriously just got padded at taxpayer expense. Since 2007, Amgen employees and its political action committee have contributed nearly $68,000 to Senator Baucus, $73,000 to Senator McConnell’s campaigns, and $59,000 to Senator Hatch.

And lo and behold, among those 74 Amgen lobbyists are the former chief of staff to Senator Baucus and the former chief of staff to Senator McConnell. You get the picture: Two guys nurtured at public expense, paid as public servants, disappear through the gold-plated revolving door of Congress and presto, return as money changers in the temple of crony capitalism.

Inside to welcome them is a current top aide to Senator Hatch, one who helped weave this lucrative loophole. He used to work as a health policy analyst for — you guessed it — Amgen.

So the trail winds deeper into the sordid swamp beneath that great Capitol dome, a sinkhole where shame has all but disappeared. As reporters Lipton and Sack remind us, just weeks before this backroom betrayal of the public interest by elected officials and the mercenaries they have mentored, Amgen pleaded guilty to fraud. Look it up: fraud means trickery, cheating and duplicity. Amgen agreed to pay $762 million in criminal and civil penalties; the company had been caught illegally marketing another one of its drugs.

The fact that their puppet master had been the subject of fines and a massive federal investigation mattered not to its servile pawns in the Senate, where pomp and circumstance are but masks for the brute power of money.

Peter Welch, Vermont’s Democratic congressman, has just introduced bipartisan legislation to repeal the half billion-dollar giveaway to Amgen. Its co-sponsors include Republican Richard Hanna of New York and Democrats Jim Cooper of Tennessee and Bruce Braley of Iowa.

The Amgen deal “confirms the American public’s worst suspicions of how Congress operates,” Representative Welch told us this week. “As the nation’s economy teetered on the edge of a Congressional-created fiscal cliff, lobbyists for a private, for-profit company seized an opportunity to feed at the public trough. It’s no wonder cockroaches and root canals are more popular than Congress.”

In his inaugural address, Barack Obama said the commitments we make to each other through Medicare, Medicaid, and Social Security don’t make us a nation of takers. But the actions of Amgen and its cronies under the dome on Capitol Hill show who the real takers are — not those who look to government for support in old age and hard times but the ones at the top whose avarice and lust for profit compel them to take as much as they can from that government at the expense of everyone else.

Bill Moyers is managing editor of the new weekly public affairs program, "Moyers & Company," airing on public television. Check local airtimes or comment

Friday, November 30, 2012

Kaiser Employee Reported Illicit Patient Charges, Fired

Most Kaiser Permanente management employees, including doctors, understand what is required of them: they must go along with whatever is needed to increase profits. This woman didn't understand how Kaiser and other healthcare entities do business.

Woman: Reported Illicit Patient Charges, Fired
By TISH KRAFT
Courthouse News
November 29, 2012

PORTLAND (CN) - Kaiser fired its director of patient access business services for reporting what she believed was patient fraud, the director says in a complaint filed in Multnomah County Court.

Aimee Mansell sued Kaiser and her boss Lisa Morrison for wrongful termination and whistle blowing.

Mansell says in her complaint that she blew the whistle on Morrison, who had "devised a policy where Emergency Department employees, including Ms. Mansell, would collect an additional 'triage' charge from Emergency Department patients, or include the triage charge on that patient's invoice for services."

Because she believed the charges to be a violation of state and/or federal law, Mansell reported these violations to defendant's complaint hotline, the court complaint says.

"On numerous occasions Ms. Mansell complained to her supervisors, human resources department, and managers at Kaiser about what she believed in good faith were different work related violations which were being committed by defendant Ms. Morrison and other Kaiser employees," her court complaint continues.

"A substantial factor in Kaiser's decision to terminate Ms. Mansell's employment was due to her fulfilling the societal obligation of reporting what she believed in good faith was patient fraud, and by protesting these triage charges which defendant Ms. Morrison had imposed or planned to impose on patient accounts," Mansell says in her complaint.

A few months before she was fired, Mansell was presented an award "In recognition of many achievements and contributions throughout the year," signed by her direct supervisor and defendant Morrison, the Patient Access Business Services Director, according to the complaint.

Plaintiff is represented by Patrick D. Angel of Portland.

Thursday, October 11, 2012

In meningitis scare, charges firm misled U.S. regulators

Corruption seems to be at the heart of so many of our health care problems.

In meningitis scare, charges firm misled U.S. regulators
By Tim Ghianni
Oct 11, 2012
(Reuters)

The deadly meningitis outbreak that has claimed a dozen lives is prompting calls for increased oversight of the nation's custom-made pharmaceutical industry, amid charges that the company at the center of the scare may have misled U.S. regulators.

On Wednesday, Idaho became the 11th state to report a case of the rare illness, which has been linked to tainted steroids produced by a specialty pharmacy in Massachusetts.

The U.S. Food and Drug Administration, whose role in the outbreak has come under criticism, said it was planning an afternoon media briefing on Thursday.

In all, 138 people have contracted meningitis as a result of the now-recalled drugs, according to the latest tally from the U.S. Centers of Disease Control and officials in 11 states where the outbreak has spread. The case in Idaho is the first discovered in the western United States.

Lawmakers have come under pressure to close what critics see as a loophole in oversight that left the New England Compounding Company (NECC), the Massachusetts pharmacy linked to the tainted steroids, largely exempt from federal regulation.

The FDA regulates only the ingredients and their suppliers, not the little-known corner of the drug world known as "compounding," which is subject to a patchwork of state oversight.

State and federal officials are now investigating NECC, which distributed thousands of vials of a contaminated steroid made at a shabby brick complex next to a waste and recycling operation in a western suburb of Boston.

The pharmacies are owned by Gregory Conigliaro, an engineer, and his brother-in-law, Barry Cadden, a pharmacist who was in charge of pharmacy operations at NECC. The waste and recycling facility is another of Conigliaro's business interests.

Compounding pharmacies such as NECC are permitted to make medications based on specific prescriptions for individual patients.

State and federal regulators are investigating why NECC shipped thousands of vials of preservative-free methylprednisolone acetate steroid to healthcare facilities in multiple states.

"It does seem like the agencies, both at the state and the federal level, may have been misled by some of the information we were given," Massachusetts Governor Deval Patrick told reporters on Wednesday.

The number of cases has grown rapidly as health practitioners contacted about 13,000 people who received injections from a potentially tainted supply of steroid medication shipped to 23 states.

In five states - Tennessee, Michigan, Maryland, Virginia, and Florida - the outbreak has claimed lives, with the latest victim a 70-year-old man in Florida.

Thousands of people received the injections to relieve back pain and other complaints and are at risk of infection...

(Writing by James B. Kelleher; Editing By Greg McCune; Desking by Vicki Allen)

Read more: In meningitis scare, charges firm misled U.S. regulators

Wednesday, July 4, 2012

Dr. Drew Pinsky responds to allegations he received GlaxoSmithKline payments

Dr. Drew Pinsky responds to allegations he received GlaxoSmithKline payments
By Michelle Castillo
July 4, 2012
(CBS News)

After being accused of taking payments from GlaxoSmithKline to promote the antidepressant Wellbutrin, Dr. Drew Pinksy told CBS News everything he said was in accordance with the law and accurate according to his medical experience.

"In the late 90s I was hired to participate in a 2-year initiative discussing intimacy and depression which was funded by an educational grant by Glaxo Wellcome," Pinksy told HealthPop in a statement. "Services for the non-branded campaign included town hall meetings, writings and multimedia activities in conjunction with the patient advocacy group the National Depresive and Manic Depressive Association (NDMDA). My comments were consistent with my clinical experience."

Pinsky - a board-certified internist, addiction medicine specialist, and radio and television personality - was mentioned in a complaint filed by the U.S. government against the pharmaceutical company, according to the Forbes.

The document states that Pinksy allegedly received two payments in March 2009 and April 2009 from GlaxoSmithKline totaling $275,000 to promote Wellbutrin SR. The Wall Street Journal reported in June 1999, he made statements on "Loveline," a television and radio show he co-hosted, saying that he prescribed Wellbutrin to depressed patients because it "may enhance or at least not suppress sexual arousal" as much as other antidepressants are known to do. Pinsky was also reported to have made comments on other media, including another national radio program called "David Essel - Alive!," Forbes added. In both instances, he did not disclose that he was paid by the company to do so, and he promote uses of Wellbutrin that had not been approved by the Food and Drug Administration.

GlaxoSmithKline recently plead guilty and had to pay $3 billion in the largest settlement of health care fraud in U.S. history, HealthPop reported. The company was charged with unlawful promotion of certain prescription drugs.

Wednesday, November 2, 2011

Bayer pays $242 million for knowingly misreporting its "best price" to HCFA and underpaying its Medicaid rebates for private labels for Kaiser

Bayer has agreed to pay $242,126,570 in damages and penalties to the federal and state governments for knowingly misreporting its "best price" to HCFA and underpaying its Medicaid rebates for Cipro and Adalat CC that was private labeled for Kaiser and PacifiCare from its determination of "best price.

CURRAN ANNOUNCES OVER $300 MILLION NATIONAL
SETTLEMENT WITH DRUG MANUFACTURERS

Maryland to Receive Approximately $2 Million
Maryland Attorney General
April 16, 2003

Attorney General J. Joseph Curran, Jr. announced today that his Medicaid Fraud Control Unit is among 48 Units nationally to reach settlements, in principle, with GlaxoSmithKline GSK and Bayer Corporation for violating the federal Medicaid drug rebate statute by failing to report "best price" information and their resulting failure to pay sufficient rebates to the state Medicaid programs in connection with their private labeling of certain drugs for health maintenance organizations.

In addition to the civil settlement, amounting to $87,600,922 in damages and penalties to the federal government and the states, GSK will enter into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General. At the insistence of the National Association of Medicaid Fraud Control Units, GSK will be required to certify its "best price" methodology. This will add a new responsibility for the manufacturer and will enhance future state enforcement.

Bayer has agreed to pay $242,126,570 in damages and penalties to the federal and state governments for knowingly misreporting its "best price" to HCFA and underpaying its Medicaid rebates for Cipro and Adalat CC that was private labeled for Kaiser and PacifiCare from its determination of "best price." Bayer will plead guilty to a charge of violating the Food, Drug and Cosmetics Act in federal district court in Boston. The government will recommend that Bayer pay a fine of $5,590,800. An addendum with new obligations will be added to Bayer’s current Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General. At the insistence of the National Association of Medicaid Fraud Control Units, the CIA will require Bayer to certify its "best price" methodology. This new responsibility will enhance future state enforcement.

The National Association of Medicaid Fraud Control Units represents the 48 federally certified Medicaid Fraud Control Units that investigate and prosecute Medicaid provider fraud.

These settlements, which include 49 states and the District of Columbia, together with two major drug manufacturers represent the largest national Medicaid fraud settlements ever.

Both Bayer and GlaxoSmithKline sold products to HMOs at deeply discounted prices, and then concealed and avoided their obligation to pay additional rebates to the Medicaid programs. This was accomplished by re-labeling or re-packaging these drugs under the HMO’s private label. This fraud scheme is referred to as "lick and stick."

The federal Medicaid drug rebate statute is designed to return money to the Medicaid program in the form of rebates from drug manufacturers. Under the statute, in order to have the pharmaceuticals eligible for Medicaid payment, all pharmaceutical manufacturers must provide "best price" information to the Centers for Medicare and Medicaid Services (formerly HCFA). "Best price" is the lowest price that a manufacturer offers its products for sale to commercial purchasers. CMS uses this "best price" information to calculate rebates payable to the state Medicaid programs under the statute.

GlaxoSmithKline

The U.S. Attorney’s Office for the District of Massachusetts conducted an investigation into alleged improprieties relating to the reported "best price" for Flonase, a nasal spray, and Paxil, an anti-depressant. Flonase was manufactured and sold by Glaxo Wellcome and Paxil was manufactured and sold by SmithKline Beecham. These two companies merged and became GlaxoSmithKline in December 2001.

Through a private labeling agreement with Kaiser Permanente, an HMO in California, Glaxo Wellcome manufactured, packaged and shipped Flonase to Kaiser, but substituted the Kaiser unique identifying number for the Glaxo Wellcome unique identifying number on the label. The purpose of the private labeling arrangement was to provide Kaiser additional price discounts on Flonase without having to report the discounted price as Glaxo Wellcome’s "best price", thereby avoiding the obligation to pay additional rebates to Medicaid under the Medicaid rebate program. Similarly, SmithKline began private labeling Paxil for Kaiser. Paxil was manufactured, packaged and shipped by SmithKline to Kaiser, but SmithKline substituted Kaiser’s unique identifying number for SmithKline’s unique identifying number on the label. SmithKline provided Kaiser additional price discounts on Paxil without reporting the newly discounted price to the Medicaid rebate program, thereby avoiding payment of additional rebates.

Kaiser Foundation Health Plan Inc. penalized $1.9 million for improper Medicare claims

Kaiser penalized $1.9 million
Pacific Business News
April 15, 2005

The U.S. and state attorneys general have penalized Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and the Hawaii Permanente Medical Group $1.9 million for making improper Medicare and Medicaid claims.

Kaiser was penalized $1 million for submitting false federal Medicare claims and $900,000 for improper state Medicaid claims.

A Kaiser employee claimed that an employee in the dermatology department had treated patients without a required state license between May 1984 and December 2001, which was confirmed by the Medicaid Fraud Control Unit, state Attorney General Mark Bennett announced Thursday.

The state said the employee who provided the treatment wasn't a licensed physician's assistant although Kaiser billed the state Medicaid program for the services provided.

The state also found that Kaiser failed to properly supervise the treatments, although the investigation didn't reveal any evidence of improper care, substandard treatment or injury to Kaiser patients.

"We take regulatory compliance very seriously at Kaiser Permanente and we regret the mistake," said Jan Head, Kaiser president.

Kaiser says the inaccurate billings to Medicare and Medicaid occurred after the state created a certification requirement for physician assistants and that the dermatology assistant practiced at Kaiser prior to the change and failed to obtain a license after the requirement went into effect.

The whistle-blowing employee filed suit in federal court under the federal and state false claims act and will receive $225,000 of the $900,000 for informing the state.

The Medicaid program will receive $115,379 for claims made based on service provided by the unlicensed service provider and the Medicaid Investigations Recovery Fund will receive $559,621 that will be used to pay for future investigations.

Monday, February 14, 2011

8 Miami-Dade County nurses prison-bound for fraud

02.05.11
8 Miami-Dade County nurses prison-bound for fraud
The Miami Herald
The Associated Press

Eight Miami-Dade County nurses have been sentenced to prison and ordered to pay restitution for helping two agencies fleece millions from Medicare.

The nurses worked for two home health care agencies, ABC Home Health and Florida Home Health Care Provider.

According to the Justice Department, each of the eight nurses pleaded guilty last year to one count of conspiracy to commit health care fraud. The nurses admitted falsifying patient records for Medicare beneficiaries to make it seem like they qualified for services from the two agencies.

The nurses' prison sentences range from five months to 2 1/2 years. Each has been ordered to pay restitution. Those amounts range from roughly $66,000 up to $699,000.

Wednesday, October 27, 2010

Glaxo Case May Not Be Over

October 27, 2010
Glaxo Case May Not Be Over
By DUFF WILSON
New York Times

The government is still following up on GlaxoSmithKline’s manufacturing problems in Puerto Rico after Tuesday’s news that the company would pay $750 million to settle criminal and civil complaints about adulterated products.

For months, federal investigators have talked about a renewed determination to hold company officials, not just corporate entities, accountable for false claims filed with government health programs that buy such products. The federal False Claims Act has recovered billions of dollars for health care fraud, but companies, not executives, are signing the plea deals.

The GlaxoSmithKline case started with a whistle-blower complaint filed six years ago by the plant’s former quality control manager. Her case ended yesterday with a $96 million share of the recovery.

The United States attorney for Massachusetts, Carmen M. Ortiz, was asked in an interview Tuesday whether there could still be any individual accountability in the case. “I really shouldn’t comment specifically in relation to this case,” she replied, “because the investigation is ongoing.”

Does that mean company officials might still be under scrutiny? “The corporate aspect is finally settled,” Ms. Ortiz replied. “I would rather not say anything else.”

One former Glaxo official was singled out in the indictment of the company in the Puerto Rico case – an unnamed person who was hired in April 2003 as the site director of the giant manufacturing facility, and accused of interfering with quality complaints. The person was removed from that job in October 2004.

In most circumstances, however, 2004 would fall outside of the five-year statute of limitations for federal misdemeanor prosecutions.

But the government can pursue individuals under a strict liability standard known as the Park doctrine — a line of prosecution that has many pharmaceutical executives worried.

Named after a 1975 Supreme Court case, that doctrine allows misdemeanor prosecution of company officials for violating the federal Food, Drug and Cosmetic Act whether or not there is evidence the official knew of the violations. The individual needs to be in a position of authority.

Wednesday, October 20, 2010

Kan doctor, wife sentenced in 'pill mill' case

Kan. doctor, wife sentenced in 'pill mill' case
By ROXANA HEGEMAN
The Associated Press
Oct. 20, 2010

WICHITA, Kan. — A Kansas doctor who ran a clinic linked to dozens of overdose deaths was sentenced Wednesday to 30 years in prison while his wife got 33 years in a case the judge said was an "avoidable tragedy motivated by greed."

Dr. Stephen Schneider looked grim and his wife blinked back tears as their sentences were pronounced in U.S. District Court in Wichita.

The Haysville couple were convicted in June of unlawfully writing prescriptions, health care fraud and money laundering. Jurors convicted them of a moneymaking conspiracy that prosecutors linked to 68 overdose deaths.

U.S. District Judge Monti Belot told the 57-year-old physician that the evidence showed that he earned and deserved the nickname "Schneider the Writer" because in many cases writing scripts was his only form of medical care.

"For whatever reason, Steven Schneider utterly failed to live up to his oath to 'do no harm,'" Belot said.

The judge said the doctor was put on every possible notice that the controlled substances he was prescribing — particularly the potent painkiller Actiq — was addicting, harming and killing his patients but did nothing to stop it.

Belot reserved some of his most scathing comments for Linda Schneider, 52, who he characterized as more culpable for creating and perpetuating the clinic as a generator of income rather than a place for competent medical care. He blamed the doctor for knowing that the clinic was mismanaged and doing nothing to stop the practice.

"Had she not been involved in the operation of the clinic, or had she approached her role there in a professional and responsible way, none of us would be here today," Belot said. "That doesn't excuse Stephen Schneider's wrongful acts, but it may somewhat explain them."

Besides conspiracy, the Schneiders were found guilty on five counts of unlawfully writing prescriptions and 11 health care fraud counts. Linda Schneider was found guilty of 15 money laundering charges while Stephen Schneider was convicted of two.

Although the doctor has no criminal record, his wife has a previous felony conviction for fraud.

"I believe the evidence has shown Linda Schneider is a scheming, manipulative, uncaring criminal who believed, erroneously, that she was smart enough to 'get away with it,'" Belot said. "A big mistake on her part."...

Thursday, February 4, 2010

Ken Lewis, Bank of America Sued by Cuomo for Fraud

Ken Lewis, Bank of America Sued by Cuomo for Fraud
February 04, 2010
By Karen Freifeld and David Scheer
Bloomberg

Former Bank of America Corp. Chief Executive Officer Kenneth Lewis was sued by New York Attorney General Andrew Cuomo for defrauding investors and the government when buying Merrill Lynch & Co. The bank agreed to pay $150 million to settle a related lawsuit by U.S. regulators.

Cuomo also sued the bank’s former chief financial officer Joe Price and the bank itself for not disclosing about $16 billion in losses Merrill had incurred before it was bought by Bank of America in an effort to get the merger approved. Afterwards, Lewis demanded government bailout funds, Cuomo said.

“We believe the bank management understated the Merrill Lynch losses to shareholders, then they overstated their ability to terminate their agreement to secure $20 billion of TARP money, and that is just a fraud,” Cuomo said today at a press conference. “Bank of America and its officials defrauded the government and the taxpayers at a very difficult time.”

Cuomo is pursuing individuals at the bank while the U.S. Securities and Exchange Commission has declined to do so. The suit is being filed under the Martin Act, a New York securities law that permits both civil and criminal penalties...