Overview
Healthcare fraud costs consumers and third-party payers, including insurance companies, Medicare, and Medicaid, up to $272 billion a year.
Stein Mitchell Beato & Missner LLP has been fighting on behalf of consumers and third-party payers against unscrupulous pharmaceutical companies, large pharmacy chains, medical device manufacturers, and hospitals for over 20 years. We have extensive experience representing clients in class actions, mass torts, multi-district litigation, and claims brought under the False Claims Act and various insurance fraud prevention statutes.
Common examples of healthcare fraud include:
Overbilling and Pricing Fraud: Pharmacies, pharmaceutical and device manufacturers, and healthcare providers are required to report certain pricing information to third-party payers in order to assure that consumers and third-party payers are charged fair and reasonable prices for drugs, devices, and services. When these prices are false, manipulated, or omitted, consumers and third-party payers may pay fraudulent and inflated prices.
Drug and Device Manufacturing Fraud: The U.S. Food and Drug Administration (FDA) regulates the quality of drugs and devices sold in the United States. FDA requires manufacturers to comply with Current Good Manufacturing Practices to ensure the drugs and devices are safe and effective. Stein Mitchell Beato & Missner LLP has unparalleled success in actions against manufacturers that engage in fraudulent practice that compromise drug and device quality. In 2013, the firm settled the largest generic drug safety case in history against Ranbaxy Laboratories Limited.
Off-Label Marketing Schemes: Federal law prohibits manufacturers from marketing or promoting drugs and devices for uses not approved by FDA. If a manufacturer markets or promotes a drug or device for uses that are inconsistent with the FDA-approved labeling, the product is misbranded.
Performance of Medically Unnecessary Procedures: Healthcare providers may not perform procedures or provide services that are not reasonable and necessary for the treatment of the patient. This includes providing services in excess of the patients’ needs, performing unnecessary diagnostic tests, inappropriately admitting patients to the hospital, performing unnecessary invasive procedures, and falsifying patient medical records to conceal the misconduct. Stein Mitchell Beato & Missner LLP recently announced a landmark settlement for unnecessary heart surgeries performed by St. Joseph Health System.
Billing Fraud: Healthcare providers must properly bill third-party payers for the services rendered and the devices provided to patients. Billing fraud can take many forms, including, for example, billing for services not rendered or devices not provided, misstating the services provided to a patient (e.g., using a billing code to obtain a higher payment than the service that was actually performed), submitting duplicative claims for reimbursement, billing for a series of procedures performed in one visit as if they were performed over multiple visits, or charging for a product or service separately rather than as part of a package (e.g., unbundling).
Anti-Kickback Statute and Stark Law Violations: Unlawful kickbacks and self-referrals interfere with the independent medical judgment of healthcare providers. In general, it is unlawful to (a) offer, pay, solicit or receive anything of value to induce or reward referrals of patients covered by government healthcare programs; and (b) refer patients for certain services to an entity with which the healthcare provider has a financial relationship.