Managed Care

March 22, 2017

DOJ discloses that it is investigating health insurance company Humana Inc., a defendant in Constantine Cannon’s whistleblower lawsuit alleging Medicare risk adjustment fraud.  Click here to read more.

February Roundup – February 17-20, 2017

Constantine Cannon attorneys quoted in articles about the DOJ joining its whistleblower lawsuit against UnitedHealth Group:

• UnitedHealth Filing Reflects DOJ’s Heightened Fraud Focus, Bloomberg BNA;
• Whistleblower suit alleges UnitedHealth defrauded Medicare, StarTribune;
• Justice Department joins Medicare Advantage fraud lawsuit against UnitedHealth, Modern Healthcare;
• Feds Join FCA Suit Targeting UnitedHealth Billing, Law360;
• United Healthcare Whistleblower Suit Provides ‘Interesting’ Investment Opportunity, The Street;
• Lawsuit says UnitedHealth tied to scheme to overbill Medicare, MINNPOST;
• DOJ joins whistle-blower suit accusing UnitedHealth of overbilling Medicare , Becker's Hospital Review;
• Justice Department joins lawsuit against UnitedHealth over Medicare billing, Minneapolis/St. Paul Business Journal;
• UnitedHealth Lower Off NYT Article Claiming Suit For Overbilling Medicare, Benzinga;
• UnitedHealth, Health Insurers Fall As DOJ Joins Whistleblower Suit, Investor's Business Daily;
• Feds join whistleblower suit that accuses UnitedHealth of inflating Medicare Advantage risk scores, Fierce Healthcare;
• United Health sinks after being sued by the US government (UNH), Business Insider;
• Feds join whistleblower lawsuit claiming UnitedHealth overcharged Medicare, TwinCities (Pioneer Press);
• UnitedHealth leads Dow losses after US joins whistleblower case, Financial Times;
• UnitedHealth shares fall after Justice Department joins Medicare whistleblower lawsuit, CNBC ;
•  UnitedHealth's Medicare business draws federal scrutiny, Minnesota Public Radio;
• DOJ joins whistleblower lawsuit against UnitedHealth Group, WellMed, Healthcare Finance News;
• Suit Says, Scheme Tied to UnitedHealth Overbilled Medicare for Years, Morning Outlook; and
• UnitedHealth Group Targeted by Whistleblower Lawsuit, Hamodia.

February 25, 2017

New York announced the arrest of Kester Atumonyogo, 43, of Valley Stream, N.Y., and his company Monack Medical Supply, Inc. (“Monack”) for allegedly stealing over $1.5 million from Medicaid and Healthfirst, a Medicaid managed care organization. The defendants are accused of using a false Social Security number to enroll Monack as a participating medical supply provider in Medicaid. Thereafter, the company allegedly filed false claims that misrepresented to Medicaid and Healthfirst that Monack dispensed a highly specialized, expensive enteral, nutritional formula to needy pediatric patients. Enteral nutritional formulas are prescribed by physicians for patients who must obtain nutrients via a feeding tube and cannot metabolize dietary nutrients from substantive food. The Medicaid reimbursement rate for specialized enteral, nutritional formula is substantially higher than off-the-shelf or over-the-counter nutritional supplements. The Attorney General’s investigation conducted by the Medicaid Fraud Control Unit (MFCU) revealed that Medicaid and Healthfirst, relying on Monack’s false claims, paid Monack for specialized enteral, nutritional formula, but that Monack only dispensed “Pediasure” or similar over-the-counter nutritional supplements to Medicaid patients, when it dispensed anything at all. NY

February 17, 2017

StarTribune features Constantine Cannon whistleblower case against UnitedHealth Group.  Click here for article.

February 16, 2017

United States joins Constantine Cannon Whistleblower’s Suit Against UnitedHealth Group for Allegedly Overcharging Medicare Hundreds of Millions. Click here for press release and here for a copy of the complaint.

August 24, 2016

New York and the Justice Department announced that three hospitals in the Mount Sinai Health System are paying a total of $2.95 million to resolve allegations that the hospitals knowingly retained over $844,000 in overpayments made by Medicaid in violation of the federal and New York False Claims Acts. Knowing retention of an overpayment from the government for more than sixty days is known as a “reverse false claim” and is a violation of both federal and state false claim acts. The entities involved include Mount Sinai Beth Israel (“Beth Israel”) (formerly Beth Israel Medical Center), Mount Sinai St. Luke’s (“St. Luke’s”) (formerly St. Luke’s Hospital) and Mount Sinai Roosevelt (“Roosevelt”) (formerly Roosevelt Hospital) (together, the “Hospitals”) – and the Hospitals’ former partnership group, Continuum Health Partners, Inc. (“Continuum,” and together with the Hospitals, “Defendants”). As part of the settlements, Defendants admitted that, beginning in 2009 due to a software compatibility issue, a coding error caused Defendants to submit claims for payment above and beyond what they had received from the managed care organization, and that Medicaid paid these claims as a secondary payor. In September 2010, the New York Office of the State Comptroller brought to Continuum’s attention a small number of these claims, and Defendants admitted that in late 2010 they were made aware of the coding error. NY