Find Corporate Waste

Tag: FCA

  • Mount Sinai Reaches DOJ Agreement Amid False Claims Act Investigation

    Logo of Mount Sinai Hospital featuring stylized mountain graphics in blue and pink, with the text 'Mount Sinai Hospital' to the right.

    Mount Sinai Health System has reached an agreement with the Justice Department resolving a federal investigation into its provision of gender-transition procedures to minors.

    Under the agreement, Mount Sinai will stop providing puberty blockers, cross-sex hormones and surgical procedures to minors.

    The health system will also pay a monetary penalty and dedicate $2 million to free medical care for individuals who report harmful consequences from gender-transition treatment received as children.

    The agreement stems from a nationwide Justice Department investigation that includes potential violations of the False Claims Act and federal health care laws.

    According to the Justice Department, investigators are examining whether providers used false diagnosis codes or other billing practices to obtain reimbursement from federal health programs and private insurers for pediatric gender-transition procedures.

    The investigation follows a January 2025 executive order directing federal agencies to take enforcement action concerning pediatric gender-transition procedures, including fraud investigations.

    Mount Sinai has allegedly ‘cooperated’ with the investigation.

    For Find Corporate Waste, the development signals another emerging area of federal health care enforcement where billing records, diagnosis coding, and federal reimbursement may become central to future False Claims Act investigations and whistleblower cases.

  • Abusive Michigan Day Care Owner Billed Medicare for Dead Patients

    Abusive Michigan Day Care Owner Billed Medicare for Dead Patients

    A Michigan adult day care owner pleaded guilty to billing Medicare for psychotherapy services that were never provided, including sessions supposedly performed after patients had died.

    According to the Justice Department⁠, Yolanda Matthews, 58, of Farmington Hills, submitted more than $539,000 in false Medicare claims.

    Matthews admitted billing for services while beneficiaries were hospitalized and filing claims under the names of social workers who no longer worked at her adult day care center. She also billed Medicare for treating beneficiaries after their deaths.

    Matthews pleaded guilty to conspiracy to commit health care fraud after being charged through the 2026 National Health Care Fraud Takedown. She faces up to 10 years in prison when sentenced on Nov. 18.

    Both Matthews and her husband were previously found responsible for abusing patients in their care.

    Link to allegations: https://adultfostercare.apps.lara.state.mi.us/Home/ViewReport/341911
  • SSM Health Pays Nearly $1M After Pharmacy Copay Waiver Allegations

    SSM Health Pays Nearly $1M After Pharmacy Copay Waiver Allegations

    This case is an example of how the Trump Administration’s Department of Justice is clawing back billions of taxpayer dollars from fraud schemes throughout the country.

    The United States has reached a $939,290 civil settlement⁠ with SSM Health Care over allegations that the retail pharmacy at Saint Louis University Hospital routinely waived patient copays, causing Medicare and the Federal Employees Health Benefits Program to overpay for prescriptions.  

    DOJ says the conduct ran from September 2020 through February 2023, with pharmacy employees allegedly waiving or failing to collect copays. That is not a harmless discount. Routine copay waivers can steer patients to one pharmacy, hide the real prescription cost, and inflate what federal programs pay.

    The case began with a qui tam whistleblower suit filed under the False Claims Act. The whistleblower will receive $159,210, while SSM will also pay $150,000 in fees and costs. SSM did not admit liability and DOJ credited the company’s cooperation and remedial action.  

    For FCW, the takeaway is direct: when providers manipulate the economics behind federally reimbursed claims, the taxpayer is left holding the bill. Copays are not paperwork. They are part of the program-integrity firewall.

  • Aquatherm Pays $1.35M Over PPP Eligibility Allegations

    Aquatherm Pays $1.35M Over PPP Eligibility Allegations

    Aquatherm, L.P.⁠ agreed to pay $1,351,575.84 to resolve False Claims Act⁠ allegations that it improperly obtained a Paycheck Protection Program⁠ loan for which it was not eligible, according to the U.S. Attorney’s Office for the District of Delaware⁠.

    DOJ said Aquatherm received an $864,982 PPP loan in March 2021 after certifying that it and its affiliates had fewer than 300 employees. Under the applicable PPP rule, that employee count included domestic and foreign affiliates.

    According to DOJ, Aquatherm is 99% owned by Aquatherm Besitzgesellschaft mbH & Co. KG, a German company. The government alleged that Aquatherm exceeded the 300-employee limit when its domestic and foreign affiliates were included, making it ineligible for the loan. Aquatherm later received full forgiveness from the SBA.

    The settlement also resolved claims brought under the qui tam⁠ provisions of the False Claims Act. DOJ said the whistleblower will receive a share of the recovery.

    The case highlights a recurring PPP enforcement issue: affiliate headcount. For public-record screening, foreign ownership, control, affiliated entities, employee count, and forgiveness records can all create eligibility questions requiring verification.

  • Arkansas Lab and Owners Pay $30M Over Alleged Kickback-Fueled Testing Scheme

    Arkansas Lab and Owners Pay $30M Over Alleged Kickback-Fueled Testing Scheme

    An Arkansas pathology lab and its owners agreed to pay $30 million to resolve federal allegations that their business model turned physician referrals and add-on testing into a taxpayer-funded billing pipeline.

    The settlement covers Advanced Pathology Solutions PLLC, APS MSO LLC, and current and former owners Kevin Hannah, Donell Burkett, and Daniel Hunter Pledger⁠. According to the Justice Department, APS operated “lean labs” with gastroenterology practices across the country and allegedly provided financial benefits to those practices in exchange for exclusive referrals of pathology specimens to APS’s North Little Rock laboratory.

    Federal prosecutors also alleged APS caused special stains and confirmatory testing to be ordered automatically before a pathologist determined whether the tests were medically necessary.

    In essence, the government alleged extra testing was built into the process first, while medical necessity came second.

    The settlement also resolves claims that APS and CEO Kevin Hannah paid volume-based commissions to Richard Sorgnard⁠ to induce referrals for epidermal nerve fiber density testing. The United States contended the commissions equaled 4% of collections from referred ENFD testing.

    The case originated from three whistleblower lawsuits filed under the False Claims Act⁠. As part of the resolution, APS entered into a five-year Corporate Integrity Agreement with HHS-OIG⁠ requiring compliance reforms, training, auditing, and review of physician referral relationships.

    For Find Corporate Waste⁠, the settlement shows how federal health care fraud can hide inside ordinary-looking referral networks, lab protocols, and billing defaults. When financial incentives shape where specimens go and testing is added before necessity is established, taxpayers are left paying for a system designed around revenue rather than care.

  • DOJ Sues to Stop Alleged Fraud in New York’s $10 Billion Medicaid Home-Care Program

    DOJ Sues to Stop Alleged Fraud in New York’s $10 Billion Medicaid Home-Care Program

    The Department of Justice⁠ filed suit in the Eastern District of New York against the New York State Department of Health, New York Medicaid Director Amir Bassiri, and Public Partnerships LLC over alleged fraud involving New York’s $10 billion Consumer Directed Personal Assistant Program, known as CDPAP.

    CDPAP is a Medicaid home-care program for patients with disabilities or significant medical needs.

    According to the DOJ, in 2024, New York consolidated hundreds of fiscal intermediaries into a single statewide administrator, ultimately awarding the contract to Public Partnerships LLC.

    The DOJ alleges that New York awarded PPL the CDPAP contract through a “sham bid process,” then failed to stop PPL from deviating from the financial limits and representations contained in its bid.

    The lawsuit⁠ also claims PPL and New York misled the public about whether the transition could be completed by April 1, 2025, despite allegedly knowing the timeline was unlikely to be met.

    The complaint alleges that CDPAP served more than 250,000 patients and 300,000 caregivers as of fall 2024. DOJ says the program bills approximately 350 million hours of care each year, meaning even small improper rate changes could generate tens of millions of dollars in unauthorized revenue.

    For Find Corporate Waste⁠, the case reflects the core oversight problem in federally funded health-care programs: public money can be lost not only through false claims, but also through weak contract enforcement, eligibility failures, and unchecked administrative control over taxpayer-funded payment streams.

  • Utah Men Charged in Alleged $5.5M IRS and SBA COVID-Relief Fraud Scheme

    Utah Men Charged in Alleged $5.5M IRS and SBA COVID-Relief Fraud Scheme

    Federal prosecutors have charged two Provo, Utah men in an alleged scheme to defraud the IRS and the Small Business Administration out of more than $5.5 million tied to COVID-era relief programs.

    According to the SBA Office of Inspector General⁠, David Starling, 61, and Benjamin Young, 39, were charged with conspiring to defraud the United States. Young was also charged with twelve counts of wire fraud. A third defendant, Adam Starling of Oregon, previously pleaded guilty.

    The government alleges the defendants owned or controlled eight companies and falsely listed family members — including spouses and children — as employees. Prosecutors say they created false tax documents reporting more than $4 million in wages, then used those documents to obtain COVID-relief benefits.

    The alleged proceeds included $3 million in tax credits and $200,000 in Paycheck Protection Program loans, which were later forgiven based on alleged false statements.

    The case also includes a separate SBA-backed loan angle. Prosecutors allege Young used fraud proceeds and embezzled funds to buy commercial space in Provo, then relied on fabricated documents to obtain a $2.5 million SBA-secured bank loan.

    For Find Corporate Waste⁠, this case is another reminder that COVID-relief enforcement is not just about the original loan. It is about payroll records, forgiveness certifications, tax filings, affiliated entities, and the paper trail behind taxpayer-backed money.

  • Former Intelligence Contractor Pleads Guilty in Kickback Scheme

    Former Intelligence Contractor Pleads Guilty in Kickback Scheme

    A former Intelligence Community contractor pleaded guilty to conspiring to commit offenses against the United States after admitting that he solicited and accepted illegal kickbacks tied to government procurement.

    According to the DOJ⁠, David Duggin, 55, of Orrtanna, Pennsylvania, was a former senior systems engineer and on-site contractor at a U.S. government Intelligence Community agency. Prosecutors said Duggin and co-conspirators used his on-site access to sensitive information to help obtain government contracts for millions of dollars of hardware and software purchased by U.S. government customers.  

    The DOJ said Duggin received at least $510,000 in illegal kickbacks in exchange for influencing the procurement process to favor his co-conspirators. The alleged conspiracy began at least as early as June 2018 and continued through at least April 2024.  

    The case is being investigated by the Defense Criminal Investigative Service and the FBI Baltimore Field Office, with prosecutors from the Antitrust Division and the U.S. Attorney’s Office for the District of Maryland. The DOJ also highlighted the Procurement Collusion Strike Force⁠, which targets bid rigging, price fixing, market allocation, and related fraud affecting government spending.

    For Find Corporate Waste⁠, the case is another reminder that taxpayer-funded procurement fraud often depends on insiders, access, and certification-driven trust. 

  • Circle Medical to Pay $3.325M Over Alleged False Healthcare Claims

    Circle Medical to Pay $3.325M Over Alleged False Healthcare Claims

    San Francisco-based Circle Medical Care of California, Circle Medical Technologies, Inc., and Chief Medical Officer Dr. Nicole Tsang, D.O., agreed to pay $3,325,000 to resolve allegations that they submitted false claims to federal healthcare programs and California commercial insurers.

    According to the DOJ⁠, Circle operates an online telehealth platform offering mental health and primary care services through contract providers, including nurse practitioners and physician assistants. The government alleged that from January 1, 2018 through May 31, 2025, Circle submitted claims using the names and NPI numbers of rendering providers who did not actually provide or supervise the services billed. The claims allegedly involved programs including Medicare, Medicaid, and TRICARE.  

    The settlement allocates $475,000 to the United States and $2.85 million to California. The matter began as a qui tam whistleblower case filed by Jason Vellen, who will receive $80,750 from the federal recovery and $997,500 from California.  

    This case fits the broader Find Corporate Waste focus on healthcare payment integrity: claims data, provider identifiers, supervision rules, and federal program billing requirements can expose recoverable taxpayer losses. 

  • Ahold Delhaize USA to Pay $40M Over Allegedly Inflated Pharmacy Prices

    Ahold Delhaize USA to Pay $40M Over Allegedly Inflated Pharmacy Prices

    Ahold Delhaize USA Inc.⁠, the parent company behind supermarket pharmacy brands including Giant, Hannaford, Stop & Shop, Food Lion, and others, has agreed to pay $40 million to resolve False Claims Act allegations involving prescription drug pricing.

    According to the DOJ⁠, Ahold Delhaize allegedly reported inflated “usual and customary” prices on claims submitted to Medicare Part D, Medicaid, and TRICARE. Prosecutors said the company operated prescription savings programs that offered discounted prices to enrolled customers, but allegedly failed to report those discounted prices as the pharmacies’ usual and customary prices.

    That distinction matters because usual and customary prices can operate as ceiling prices in federal health care reimbursement formulas. The government alleged that by reporting higher prices, Ahold Delhaize caused federal health care programs to pay more than they should have paid on pharmacy claims.

    Of the $40 million settlement, $32.9 million represents the federal share, with the remainder going to participating states.

    The case began as a whistleblower action filed by Lawrence LaBenne, a Pennsylvania pharmacist at an Ahold Delhaize supermarket.

    He will receive $6,083,587 from the federal recovery.

    The settlement is another example of how pricing representations, claim-level billing data, and insider knowledge drive many False Claims Act recoveries.

    For Find Corporate Waste⁠, the case fits the broader enforcement pattern: federal programs rely on accurate certifications and truthful claim data, and public money can be recovered when those representations are allegedly false.