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Medicare Fraud?: Cigna, UnitedHealth Group, and Aetna Under Scrutiny for Possible Kickback Violations

Senate Finance Committee Chair Max Baucus (D, Mont.) and Senator Charles Grassley (R, Iowa) of the Senate Judiciary Committee are looking at whether insurers’ practice of directing tests to specific labs in return for payments or discounts from the labs violate federal anti-kickback laws. This practice is known as “pull through.”

Earlier this month, the two senators sent a letter to insurers Cigna, UnitedHealth Group, and Aetna, as well as to clinical labs Laboratory Corp of America and Quest Diagnostics. It was just this May that Quest settled for $241 million a California whistleblower lawsuit with the state. The medical lab testing provider was accused of overcharging California’s Medicaid program for over 15 years and issuing illegal kickbacks to doctors, clinics, and hospitals. This often took the form of discounted rates and free tests for referring patients and other parties to the labs. Even though it agreed to settle, Quest was not admitting to wrongdoing and continued to stand by testing rates. The whistleblower settlement, however, was the largest recovery under California’s False Claims Act. The state is pursuing similar claims against other lab companies.

Pull-through deals have raised concerns for the Human Services Office of Inspector General and the Department of Health. This type of arrangement between a clinical lab and an insurance company violates federal anti-kickback laws, which bar anyone from knowingly and willingly receiving payment for something of value to influence the referral of federal health care program business.

Medicare Fraud
Medicare fraud costs taxpayers billions of dollars annually. Those that work in the industry that choose to expose this type of fraud can be rewarded up to 30% of what the government collects. Filing a Massachusetts whistleblower lawsuit also lets you sue those committing Boston Medicare billing fraud on the government’s behalf.

2 senators probe insurers and labs for possible kickback violations, Amednews.com, November 21, 2011
Quest Diagnostics settles Medi-Cal whistle-blower suit, Los Angeles Times, May 20, 2011

More Blog Posts:
Whistleblower Lawsuit Accuses Florida Hospital of Defrauding Medicare of $2M, Boston Injury Lawyer Blog, November 15, 2011
Pfizer Settles Whistleblower Claim Alleging Pharmaceutical Fraud Related to Detrol, Boston Injury Lawyer Blog, October 19, 2011
Whistleblower in Bank of New York Mellon Corp. Probe to Receive Reward for Helping the Justice Department, Boston Injury Lawyer Blog, October 13, 2011
Please contact Altman & Altman and let one of our Boston injury lawyers know that you would like more information about your potential Massachusetts whistleblower claim.