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Medicaid Law
 
Salomon G. martinez v. Department of Health Care Services

The California Department of Health Care Services
(Department) moved to determine the amount of a Medi-Cal lien
on the settlement of plaintiff’s medical malpractice action. (Welf.
& Inst. Code, § 14124.76, subd. (a)1.) The trial court determined
the amount of the lien to be $39,004.41. Plaintiff appeals. We
reduce the amount of the lien by 25 percent for statutory attorney
... More...
   $0 (01-16-2018 - CA)

Don Karms and Robert Parker v. Kathleen Shanahan, Sandra McKeon Crow and New Jersey Transit District of New Jersey Federal Courthouses

Don Karns and Robert Parker filed civil rights actions against the New Jersey Transit Corporation (“NJ Transit”) and NJ Transit Officers Kathleen Shanahan and Sandra McKeon Crowe in their official and individual capacities, alleging violations of the First, Fourth, and Fourteenth Amendments. Officers Shanahan and Crowe arrested Karns and Parker for defiant trespass and obstruction of justice after... More...   $0 (01-14-2018 - NJ)

United States, et al., ex rel. Abendano v. NCDR, LLC, et al. District of Connecticut Federal Courthouse - Bridgeport, Connecticut

New Haven, CT - Dental Management Company Benevis and its Affiliated Kool Smiles Dental Clinics to Pay $23.9 Million to Settle False Claims Act Allegations Relating to Medically Unnecessary Pediatric Dental Services

The Justice Department announced today that it has settled False Claims Act allegations against dental management company Benevis LLC (formerly known as NCDR LLC) and more tha... More...
   $33000000 (01-13-2018 - CT)

United States of America v. Gibson Buckley Condie District of Wyoming Federal Courthouse - Cheyenne, Wyoming

Cheyenne, WY - Powell, Wyoming Psychologist Sentenced to Three Years in Prison for Health Care Fraud

Gibson Buckley Condie, 57, of Powell, Wyoming, was sentenced on January 8, 2018, to serve three years in prison for felony health care fraud involving mental health services falsely billed to Wyoming Medicaid, announced United States Attorney Mark A. Klaassen. Condie was also ordered to pa... More...
   $0 (01-10-2018 - WY)

United States of America v. Kim Ricard Eastern District of Louisiana Federal Courthouse - New Orleans, Louisiana

New Orleans, LA - New Orleans Area Woman Sentenced to More Than Four Years in Prison for Role in Approximately $2 Million Home Health Kickback and Identity Theft Scheme

A New Orleans woman was sentenced today to 51 months in prison for her involvement in a $2 million home health kickback scheme carried out through a New Orleans area home health agency.

Kim Ricard, 51, of Gonzales... More...
   $1958000 (01-05-2018 - LA)

Carlos Morales v. David Barnes Dallas County Courthouse - Dallas, Texas

Appellant Carlos Morales asserts that the trial court erred in denying his motion to dismiss pursuant to chapter 27 of the Texas Civil Practice & Remedies Code. Morales also asserts that the trial court abused its discretion in granting appellee David Barnes’s motion to disregard Morales’s reply to Barnes’s response to motion to dismiss. We affirm in part and reverse in part.
BACKGROUND
Ba... More...
   $0 (12-31-2017 - )

United States of America v. EmCare, Inc. a subdivision of Envision Healthcare Corporation Western District of North Carolina Courthouse - Charlotte, North Carolina

Charlotte, NC - EmCare, Inc. to Pay $29.8 Million To Resolve False Claims Act Allegations

The Department of Justice on December 19, 2017 announced a settlement with Dallas based EmCare, Inc. a subdivision of Envision Healthcare Corporation that provides physicians to hospitals to staff their Emergency Departments (EDs). EmCare agreed to pay $29.8 million to resolve claims that, from 2008... More...
   $29800000 (12-28-2017 - NC)

United States of America, et rel. Garbe v. Kmart Corporation Southern District of Illinois Federal Courthouse - Benton, Illinois

Kmart Corporation to Pay U.S. $32.3 Million to Resolve False Claims Act Allegations for Overbilling Federal Health Programs for Generic Prescription Drugs

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation (SHC), has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescripti... More...
   $32300000 (12-26-2017 - IL)

United States of America v. Bertha Blanco Southern District of Florida Courthouse - Miami, Florida

Miami, FL - Former Florida State Health Care Administration Official Sentenced to More Than Four Years in Prison for Accepting Bribes

A former employee of Florida’s Agency for Health Care Administration (AHCA) was sentenced today to 57 months in prison for accepting bribes in exchange for providing confidential information about health care facilities that received Medicare and Medicaid f... More...
   $0 (12-15-2017 - FL)

United States ex rel. Darla Reid v. Med-Fast Pharmacy, Inc. Western District of Pennsylvania Courthouse - Pittsburgh, Pennsylvania

Pittsburgh, PA - Iserve Technologies, Inc. Pled Guilty in Connection with Guilty Pleas of Former Exec and Manager of Med-Fast Pharmacy Inc.

Individuals and entities associated with Med-Fast Pharmacy, Inc. (“Med-Fast”) have resolved criminal and civil charges associated with Med-Fast’s improper submission of claims to the Medicare and Medicaid programs.

Iserve Technologies, Inc., ... More...
   $0 (12-13-2017 - PA)

United States of America v. Yunesky Fornaris Southern District of Florida Courthouse - Miami, Florida

Miami, FL - Owner of Miami Home Health Agency Sentenced to More Than Nine Years in Prison for Role in $15 Million Medicare Fraud Conspiracy

The owner and operator of a defunct Miami, Florida home health agency was sentenced to 115 months in prison on December 11, 2017 for his role in a $15 million conspiracy to defraud the Medicare program.

Yunesky Fornaris, 38, of Miami, was se... More...
   $0 (12-12-2017 - FL)

UNITED STATES OF AMERICA v. MOHSIN RAZA UNITED STATES OF AMERICA v. FARUKH IQBAL, UNITED STATES OF AMERICA v. MOHAMMAD ALI HAIDER UNITED STATES OF AMERICA v. HUMAIRA IQBAL United States Court of Appeals for the Fourth Circuit

On April 23, 2015, a federal grand jury in Alexandria, Virginia, returned a seven
count indictment against the defendants — who were former employees of SunTrust’s
Annandale branch.2 The indictment’s first count charged them with conspiracy to commit wire fraud affecting a financial institution, in contravention of 18 U.S.C. § 1349.3
Counts 2 through 7 made substantive allegations ... More...
   $0 (12-03-2017 - )

UNITED STATES OF AMERICA, EX REL ANTHONY R. SPAY v. CVS CAREMARK CORPORATION; CAREMARK RX UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT

Part D of the Medicare program is a voluntary prescription drug benefit program that subsidizes the cost of prescription drugs and prescription drug insurance premiums for Medicare enrollees.2 The Part D program operates as a public-private partnership between the Centers for Medicare and Medicaid Services (“CMS”) and government contractors. CMS contracts with private insurance companies called “S... More...   $0 (12-03-2017 - PA)

The People of the State of New York v. Stan XuHui Li Pain Clinic Doctor Is Sentenced in Overdose Deaths of 2 Patients

Defendant was a physician specializing in pain management. In 2004, he opened a pain management clinic in Queens. According to the People, the clinic was nothing more than a "pill mill" catering to people who were hopelessly addicted to pain medicine, primarily opioids. The People's evidence showed that, despite having been trained in the wide variety of methods for identifying legitimate pain and... More...   $0 (12-02-2017 - NY)

David Richard Sizemore v. Nancy A. Berryhill United States Court of Appeals for the Third Circuit

David Sizemore applied for disability benefits from the Social Security
Administration in July 2011, claiming that he was disabled due to diabetes and bipolar
disorder. After his application was denied by an administrative law judge (“ALJ”), who
found that Sizemore was not disabled, and review was denied by the Appeals Council, he
commenced this action in the district court. The di... More...
   $0 (12-01-2017 - NC)

United States of America v. Cardiovascular Consultants Heart Center (CVC Heart Center), et al. Eastern District of California Federal Courthouse - Fresno, California

Fresno, CA - CVC Heart Center to Pay $1.2 M to Settle Allegations of Billing Health Care Programs for Medically Unnecessary Nuclear Stress Tests

Cardiovascular Consultants Heart Center (CVC Heart Center), a cardiology clinic with offices in Fresno and Clovis, and its shareholder physicians — Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory, and Dr. William Hanks — ... More...
   $1200000 (11-29-2017 - CA)

United States of America v. Aharon Aron Krkasharyan Central District of California Federal Courthouse - Los Angeles, California

Los Angeles, CA - Former Employees of Southern California Ambulance Company and Dialysis Center Plead Guilty to Medicare Fraud Charges

A former employee of a Southern California ambulance company and a former employee of a Los Angeles dialysis treatment center both pleaded guilty on November 27, 2017 to fraud charges for their roles in a fraud scheme that resulted in more than $6.6 millio... More...
   $0 (11-28-2017 - CA)

United States of America v. Charissie Davis Central District of Illinois Federal Courthouse - Urbana, Illinois

Urbana, IL - Decatur Woman to Serve 18 Months in Prison for Defrauding Home Services Program

A Decatur, Ill., woman, Charissie Davis, was sentenced on November 20, 2017 to serve 18 months in federal prison for defrauding the Home Services Program, a Medicaid waiver program. The health care benefit program provides funding to pay personal assistants who aid qualifying disabled individuals ... More...
   $0 (11-27-2017 - IL)

United States of America v. Thaddeus M.S. Bereday Middle District of Florida Federal Courthouse - Tampa, Florida

Tampa, FL - Former Wellcare General Counsel Sentenced For False Statements To The Florida Medicaid Program

Thaddeus M.S. Bereday pleaded guilty on June 26, 2017.

A federal grand jury in the Middle District of Florida returned an indictment on March 2, 2011, charging five former WellCare Health Plans, Inc. (“WellCare”) executives (Todd S. Farha, Paul L. Behrens, William L. Kale, P... More...
   $0 (11-25-2017 - FL)

United States of America, ex rel. Anthony R. Spay v. CVS Caremark Corporation Third Circuit Court of Appeals - Philadelphia, Pennsylvania

We are asked to consider the viability of two potential defenses to an alleged False Claims Act violation that arise in the context of the Medicare Part D Program: the government knowledge inference, which can defeat a finding of scienter in certain circumstances, and the element of materiality.1 The District Court relied upon the government knowledge inference doctrine in dismissing the claims. A... More...   $0 (11-23-2017 - )

Eileen Bransten v. State of New York New York Court of Appeals Hall - Albany, New York

The issue presented on this appeal is whether Civil Service Law § 167 (8), as amended, authorizing a reduction of the State's contribution to health insurance benefits for State employees, including members of the State judiciary, violates the Judicial Compensation Clause [*2]of the State Constitution (NY Const, art VI, § 25 [a]). We conclude the State's contribution is not judicial compensation p... More...   $0 (11-21-2017 - NY)

United States of America v. Suzanna Meliksetyan Eastern District of New York Courthouse - Brooklyn, New York

Brooklyn, NY - Operator of Purported Durable Medical Equipment Providers Pleads Guilty to Health Care Fraud Charges for Role in Fraud Scheme

Suzanna Meliksetyan, an operator of multiple purported durable medical equipment (DME) companies pleaded guilty to one count of conspiracy to commit health care fraud for her role in a scheme to defraud Healthfirst, a non-profit, New York-based healt... More...
   $0 (11-20-2017 - NY)

Artur Hefczyc v. Rady Children's Hospital-San Diego

Artur Hefczyc appeals from an order denying his motion for class certification in
his lawsuit against Rady Children's Hospital-San Diego (Rady). On behalf of a proposed
class, Hefczyc seeks declaratory relief to establish that Rady's form contract, signed by
2
patients or guarantors of patients who receive emergency room care, authorizes Rady to
charge only for the reasonable ... More...
   $0 (11-18-2017 - CA)

United States ex rel. Academy Health Center, Inc. v. Hyperion Foundation, Inc., et al. Southern District of Mississippi - Federal Courthouse - Jackson, Mississippi

Jackson, MS - Mississippi Skilled Nursing Facility, Related Companies, and Executives Agree to Pay $1.25 Million to Settle False Claims Act Allegations of Grossly Substandard Care to Facility Residents

The Department of Justice announced today that Hyperion Foundation, a Georgia not-for-profit entity (Hyperion), Julie Mittleider, a resident of Georgia and Hyperion’s former President, Alta... More...
   $1250000 (11-16-2017 - MS)

United States of America v. Gurcharan Singh Kanwal Western District of Virginia Federal Courthouse - Abingdon, Virginia

Abingdon, VA - Coeburn Doctor Pleads Guilty to Health Care Fraud, Distributing Ritalin - Gurcharan Kanwal Agrees to Surrender Medical License; Never Practice Medicine Again

A Coeburn, Virginia doctor, who prescribed Ritalin and hydrocodone to an undercover investigator without a legitimate medical purpose, pleaded guilty on November 9, 2017 to federal health care fraud and drug distribut... More...
   $0 (11-14-2017 - VA)

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