FBI makes eight arrests in $633M pharmacy scheme 

The FBI and the U.S. Department of Justice charged eight Florida residents in a $633 million fraud scheme involving pharmacies in the Tampa Bay and Miami areas, the agencies announced

The eight individuals, from New Port Richey, Boca Raton, Fort Lauderdale and Parkland were charged in a 12-count indictment unsealed earlier this month.

The eight defendants are accused of using compounding pharmacies in New Port Richey and Miami to obtain roughly $157 million in reimbursements from October 2012 through December 2015, according to the indictment. The individuals are charged with conspiracy to commit health care fraud and wire fraud. Five of the eight co-conspirators also were accused of a trio of money laundering charges. read more »

Deion Sanders fighting allegations of bilking National School Lunch Program

an attorney for Dallas Cowboy legend and failed charter school founder Deion Sanders has asked a federal court to deny a default judgment in a lawsuit accusing Sanders and others of cheating the federal government out of $1.5 million by misusing subsidized lunch funds.

Plaintiffs against Sanders are seeking the default judgment because Sanders’ lawyer, John D. Nation, missed a deadline to respond to court filing read more »

SEC Charges Former Professional Football Player With Running $10 Million Fraud

The Securities and Exchange Commission today charged Merrill Robertson Jr., a former player for the Philadelphia Eagles, with defrauding investors, including coaches he knew from his time playing football for the Fork Union Military Academy and the University of Virginia.

The SEC’s complaint, filed in federal court in Richmond, Virginia, charges Robertson, Sherman C. Vaughn Jr., and the company they co-owned, Cavalier Union Investments LLC.  According to the complaint, the defendants promised to invest in diversified holdings but diverted nearly $6 million of the more than $10 million they raised from investors to pay for personal expenses and used other funds to repay earlier investors. read more »

Insurers Must Face Medicare Advantage FCA Suit: 9th Circ.

Aetna, UnitedHealthcare and WellPoint must face a False Claims Act suit accusing them of turning a blind eye to faulty diagnoses in order to reap bigger Medicare Advantage payments, the Ninth Circuit ruled Wednesday in a closely watched case.

In a published opinion, the circuit said that a district judge erred in refusing to let whistleblower James M. Swoben amend his complaint, which alleges manipulation of so-called risk adjustment payments that offset the costs of sicker Medicare Advantage beneficiaries. read more »

9th Circ. Says Radiologist Sufficiently Pled FCA Case

The Ninth Circuit on Tuesday revived a whistleblower’s False Claims Act suit against a California physician, practice group and hospital, concluding he outlined specific enough examples of alleged Medicare fraud to allow him to file a second amended complaint.

The three-judge panel agreed radiologist Scott H.M. Driscoll sufficiently alleged that his former employer Todd Spencer M.D. Medical Group Inc., its principal Todd Spencer and Madera Community Hospital provided unnecessary CT Scans and then artificially inflated its billings for procedures. The judges remanded the case and ordered the court to let Driscoll amend his complaint. read more »