United States Files Civil Fraud Lawsuit Against Cigna For Artificially Inflating Its Medicare Advantage Payments

DOJ

Damian Williams, the United States Attorney for the Southern District of New York, announced that the United States has filed a civil healthcare fraud lawsuit against CIGNA CORPORATION and its subsidiary Medicare Advantage Organizations (collectively, “CIGNA”).  The lawsuit seeks damages and penalties under the False Claims Act for CIGNA’s submissions to the Government of false and invalid patient diagnosis codes to artificially inflate the payments CIGNA received for providing insurance coverage to its Medicare Advantage plan members.  The Government is intervening in a lawsuit filed by a whistleblower, which was originally filed in the United States District Court for the Southern District of New York and later transferred to the Middle District of Tennessee. read more »

Sutter Health Agrees To Pay $13 Million To Settle False Claims Act Allegations Of Improper Billing For Lab Tests

DOJ

Sutter Health, a Sacramento-based health care services provider, and its affiliate Sutter Bay Hospitals, the successor to Sutter East Bay Hospitals dba Alta Bates Summit Medical Center (collectively Sutter Health), agreed to pay more than $13 million to settle allegations that it violated the False Claims Act by billing the United States for toxicology screening tests performed by outside labs, announced United States Attorney Stephanie M. Hinds; Federal Bureau of Investigation San Francisco Special Agent in Charge Robert K. Tripp; Office of Personnel Management Office of Inspector General (OPM OIG) Special Agent in Charge Amy K. Parker; Department of Health and Human Services Office of Inspector General (HHS-OIG) Special Agent in Charge Steven J. Ryan; Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS) Western Field Office Special Agent in Charge Bryan D. Denny; and the Defense Health Agency (DHA). read more »

Federal Court Concludes Receivership in CFTC Ponzi Scheme Action Resulting in the Recovery of Over $1 Billion

CFTC

The Commodity Futures Trading Commission today announced the successful conclusion of the receivership in CFTC v. Walsh, et al., a $1.3 billion Ponzi scheme case the CFTC filed in 2009. [See CFTC Press Release No. 5621-09]. On September 19, the U.S. District Court for the Southern District of New York approved the receiver’s final account and report, discharged the receiver, and accepted the receiver’s request to deposit the remaining receivership funds with the court. read more »

U.S. Supreme Court turns down chance to review False Claims Act standard

REUTERS

The U.S. Supreme Court on Monday declined to hear three cases over whether whistleblowers accusing providers of defrauding the government must provide details about alleged false claims submitted by the providers. read more »