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South Florida Businessman Charged with $1 Billion Medicare Fraud

- Miami Herald
In what seems to be the largest case of Medicare fraud in South Florida to date, a local businessman has been accused of $1 Billion in fraud spanning 14 years. Philip Esformes has pleaded not guilty to the following charges: conspiracy, obstruction, money laundering, and health care fraud. His alleged scheme involved numerous providers and individuals, some of which have already made deals in exchange for their testimony.
Esformes owns a network of nursing homes and assisted living...

Pfizer's Medicaid Swindling Claim $785M Settlement Benefits Frequent Whistleblower

- Wall St. Journal
Drug giant Pfizer Inc. has revealed it reached an agreement in principle to pay $784.6 million to resolve allegations that it systematically overcharged Medicaid for the heartburn drug Protonix.
Merely weeks before the trial, which was scheduled to begin in Boston on March 7th, Pfizer and the US Department of Justice have reportedly agreed to settle according to the Wall St. Journal, although the final agreement and court approval are still pending.
The alleged overcharging was...

Whistleblower Lawsuit Settles at $46.7M on Centerlight's Enrollment of Ineligibles in Medicaid Long-Term Care Plan

- NY Attorney General Announcement
A lawsuit filed by whistleblower David Heisler under the False Claims Act has resulted in the recovery of $46.7 million from New York-based Centerlight Health Inc. and Centerlight Health System Inc. (collectively, Centerlight) according to a statement by the NY State Attorney General’s office.
The settlement resolves allegations that Centerlight enrolled ineligible members in their Medicaid long-term care plan (MLTCP). The State of New York charged Centerlight with enrolling 1,241...

Novartis $370 Million Medicaid Fraud Settlement - Alleged Kickback Scheme on High-priced Prescription Drugs

- USA Today
Novartis Pharmaceuticals has agreed to pay $370 million dollars after admitting responsibility for offering kickbacks to pharmacies that consistently recommended high-price prescription drugs Exjade and Myfortic. Novartis has simultaneously agreed to forfeit $20 million of proceeds from the scheme.
These unlawful practices were brought to light by whistleblower David Kester, a Novartis Area Sales Manager, who kickstarted the investigation by filing a lawsuit under the False Claims Act...

Strata Pathology Pays $559,000 on Whistleblower’s Allegations of Illegal Physician Referrals

- Boston Globe
Strata Pathology Laboratory, Inc. of Lexington, Massachusetts, has agreed to pay $559,000 to resolve claims that it was in the habit of paying doctors kickback fees for patient referrals, which ultimately resulted in extra expenses for Medicare and Medicaid, as well as private insurers.
The resolution is the result of a whistleblower lawsuit by former Strata employee Henry O'Dell, who decided to pursue the matter after observing that the company allegedly struck deals with physicians to...

Whistleblowers Recover $3.7 Million from Adventist Health System in Medicaid Fraud Case

- Whistleblower News Review
Adventist Health System will pay four US states over $3.7 million in a Medicaid False Claims Act case brought forth by whistleblowers Michael Payne, Gloria Pryor, and Melissa Church according to this news article in Whistleblower News Review. The settlement represents a further financial blow to Adventist Health, after it was forced to pay the Federal Government $115 million in connection with related allegations.
Medicaid Billing & Kickback Fraud Alleged in FL, NC, TN and...

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