Whistleblowers’ Lawsuit Leads to Massive Medical Fraud Settlement

What started seven years ago as a whistleblower lawsuit filed by two Charlotte-area doctors ended Tuesday with two emergency room physicians groups paying federal and state governments more than $33 million to avoid going to court, according to a report by The Charlotte Observer.

“The payments cap off longstanding allegations of a vast medical-fraud conspiracy between a major hospital chain and the physicians groups that bilked federal and state healthcare programs in North Carolina and five other states out of millions of dollars,” writes Michael Gordon.

He explains that prosecutors allege that EmCare physicians took kickbacks and other inducements from Health Management Associates, a now defunct chain of acute-care hospitals, to recommend that their patients be admitted to HMA hospitals rather than receive outpatient care. Then the doctors would order expensive and unnecessary tests, resulting in Medicare and Medicaid reimbursements to the hospitals.

Read the Observer article.

 

 




Ex-WellCare General Counsel Pleads Guilty in Florida Medicaid Case

Reuters is reporting that an ex-general counsel of insurer WellCare Health Plans Inc. pleaded guilty on Wednesday in federal court in Tampa to having made a false statement to Florida’s Medicaid program, prosecutors said, the latest former executive to be convicted in the case.

Thaddeus Bereday, indicted along with four other former WellCare executives in 2011, faces a maximum of five years in prison.

“Bereday’s plea came after the U.S. Supreme Court in April declined to hear an appeal by former WellCare Chief Executive Todd Farha of his fraud conviction for his role in a scheme to cheat the Medicaid health insurance program for the poor,” writes reporter Nate Raymond.

Read the Reuters article.

 

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Disbarred KC Lawyer Pleads Guilty in $1.2 Million Theft From St. Luke’s Health System

A recently disbarred Kansas City lawyer pleaded guilty Wednesday to embezzling more than $1.2 million from St. Luke’s Health System, reports The Kansas City Star.

Alan B. Gallas, 64, previously worked for a law firm that collected from patients who were behind on payments to the hospital system. He waived his right to a grand jury and pleaded guilty in U.S. District Court in Kansas City to mail fraud.

“Gallas admitted that from 2009 to July 2015, he defrauded St. Luke’s Health System out of $1,224,264,” the report says. “He must pay that amount in restitution as part of Wednesday’s plea agreement.”

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