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Tag Archives: fca

June 30

False Claims Act

Pandemic Era Telehealth Fraud Under the False Claims Act

Pandemic Era Telehealth Fraud Before the COVID-19 pandemic, Medicare had strict limitations for telehealth service eligibility for beneficiaries. Generally, telehealth services were only covered for beneficiaries in rural regions or areas with scarce availability of healthcare professionals. With emerging trends data from the Center for Medicare & Medicaid Services (“CMS”), the once temporary pandemic-era expansions of telehealth service eligibility under Medicare and Medicaid might turn into more permanent fixtures of the healthcare industry. The expansion to telehealth services was in response to the COVID-19 Public Health Emergency (“PHE”). Changes occurred nearly overnight, with many different aspects of virtual medical services suddenly eligible for payment from federal health…

June 02

Whistleblowers, FCA Qui Tam

IRS Whistleblower Program Reform: What Proposed Changes Mean for Tax Enforcement and Whistleblowers

The House Ways and Means Committee unanimously approved House Resolution 7959, the IRS Whistleblower Program Improvement Act, marking a significant step towards IRS whistleblower program reform. This bill aims to streamline IRS whistleblower awards, protect whistleblowers’ anonymity, and improve transparency around the largest tax avoidance schemes. For companies, individuals, and tax fraud enforcement advocates, the legislation signals a meaningful shift in how the government incentivizes and protects those who expose wrongdoing. How the IRS Whistleblower Program Currently Works The tax whistleblower program determines awards in two…

October 20

Whistleblowers, FCA Qui Tam

Semler Scientific and Cipria Pay $37 Million to Resolve Medical Device Fraud Allegations

Semler Scientific and Bard Peripheral Vascular Pay $37 Million to Resolve Medical Device Fraud Allegations Semler Scientific Inc. (“Semler Scientific”) and Bard Peripheral Vascular Inc. (“Bard Inc.”) have agreed to pay nearly $37 million to settle allegations that they violated the False Claims Act (“FCA”) by promoting medical devices that were not eligible for Medicare reimbursement as if they met coverage and billing requirements. The case highlights how whistleblowers continue…

October 14

Whistleblowers, FCA Qui Tam

A $60 Billion Problem: Annual Medicare Losses Due to Fraud and Abuse

According to the Senior Medicare Patrol, Medicare loses an estimated $60 billion every year to fraud, errors, and abuse. From telehealth billing scams to genetic testing fraud, DME schemes to PBM misconduct, and other unlawful schemes, Medicare fraud is a serious—and seriously expensive—issue that affects all taxpayers. The scale of this waste highlights the critical role of the False Claims Act and whistleblowers in protecting the integrity of federal programs…

August 28

Whistleblowers, FCA Qui Tam

Billions Recovered Through the IRS Whistleblower Program

Whistleblowers and the IRS Whistleblower Program have been vital in promoting fairness and accountability within the nation’s tax administration. As of June 2025, the IRS has paid over $1.3 billion awards based on the successful collection of $7.5 billion in restitution from noncompliant taxpayers, since issuing its first award in 2007. In Fiscal Year 2024, the IRS paid awards totaling $123.5 million based on whistleblower information on tax and other…

August 04

FCA Qui Tam, Whistleblowers

Renewed Push for Pennsylvania False Claims Act Builds on Local Successes in Philly and Allegheny County

Bipartisan Efforts to Pass a Statewide Pennsylvania FCA On February 17, 2025, Pennsylvania State Senators Lindsey M. Williams (D-Allegheny) and Kristin Phillips-Hill (R-York) reintroduced SB 38, the Commonwealth Fraud Prevention Act for Taxpayer Accountability (CFPA). This statewide False Claims Act (“FCA”) would build on existing local laws in Philadelphia and Allegheny County that protect public funds and whistleblower rights by allowing Pennsylvania to recover a greater share of funds involving…

July 17

FCA Qui Tam, Whistleblowers

Contractor to Pay $1 Million to Settle Allegations of Overcharging U.S. Air Force

A federal contractor, Noble Supply & Logistics, LLC (“Noble”), has agreed to pay $1 million to resolve allegations that it overcharged the United States Air Force for services provided at Cannon Air Force Base, in violation of the False Claims Act (“FCA”). Defense contractor fraud is one of the oldest forms of fraud and dates back to the very creation of the FCA, which was established to combat defense contractor…

July 10

FCA Qui Tam, Whistleblowers

New York Medicaid Fraud: AG James Nets $13M from Fake Medical Transportation Billing

On June 30, 2025, New York Attorney General (NYAG) Letitia James announced that her office successfully investigated 25 transportation companies for billing Medicaid for fraudulent trips, such as nonexistent rides, inflated mileage, and illegal patient kickbacks, securing over $13 million in settlements. How Transportation Companies Committed Billing Fraud Millions of New Yorkers rely on Medicaid and Medicaid-covered services, including transportation to and from healthcare facilities. Unfortunately, some companies have taken…

July 02

FCA Qui Tam, Whistleblowers

$9.2 Million Healthcare Kickback Settlement Highlights Ongoing FCA Enforcement

A recent $9.2 million settlement by hospice company Creative Hospice Care, Inc. Illustrates the power of the False Claims Act (“FCA”) in combating healthcare fraud. In 2024, the Department of Health and Human Services collected recoveries totaling $1.67 billion from FCA cases. How does the Anti-Kickback Statute intersect with False Claims Act enforcement? The False Claims Act (“FCA”), 31 U.S.C. § 3729, et seq., is a civil war era statute…

May 30

FCA Qui Tam, Whistleblowers

Missouri Man Pleads Guilty in $8.7 Million Genetic Testing Fraud Scheme

On May 29, 2025, Missouri man Jamie McNamara, pleaded guilty to his role in a conspiracy involving fraudulent Medicare claims for unnecessary genetic testing and durable medical equipment (DME), made possible using sham telemedicine consultations. According to the DOJ, McNamara operated laboratories in Louisiana and Texas, which he utilized to enact the scheme. The labs hired telemarketers to call Medicare beneficiaries and convince them to agree to genetic testing and…

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