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January 10, 2024

Clinical laboratory RDx Bioscience Inc. and its owner and CEO Eric Leykin have agreed to pay over $10 million to the federal government and about $3 million to the State of New Jersey for violating the Anti-Kickback Statute and federal and state False Claims Acts.  From 2018 to 2022, RDx and Leykin were allegedly involved with five types of kickback schemes in order to induce referrals to RDx for laboratory testing, then submitted or caused false claims to be submitted to Medicare and Medicaid that were unnecessary or uncovered.  DOJ

December 21, 2023

A Florida woman who submitted over $192 million in claims to Medicare for medically unnecessary and unprovided tests, equipment, and services, has been sentenced to 20 years in prison.  Elizabeth Hernandez ordered thousands of genetic testing and orthotic braces for patients she never spoke to or examined, ultimately ordering more cancer genetic tests than any other provider in the nation.  She also billed for thousands of telemedicine visits that she never performed, often billing for over 24 hours in a single day.  DOJ

November 16, 2023

A Florida man who was the Chief Compliance Officer of pharmacy holding company A1C Holdings LLC has been ordered to pay $21.7 million in restitution for his role in a $50 million fraud scheme against Medicare.  Pharmacies associated with Steven King and his co-conspirators allegedly secured prescriptions and refills for medically unnecessary lidocaine and diabetic testing supplies, and took steps to avoid oversight by registering as brick-and-mortar pharmacies, concealing their ownership, and shipping expensive prescriptions without patient authorization.  DOJ

October 18, 2023

The president of a California-based medical technology company has been sentenced to 8 years in prison and ordered to pay $24 million in restitution in the first COVID-related criminal securities fraud case charged by DOJ and the first COVID-related criminal healthcare fraud case brought to trial.  Among many things, Mark Schena of Arrayit Corporation was found to have taken advantage of the pandemic by claiming he and his company had developed a technology to test for just about any disease, including COVID, using a single drop of blood.  In doing so, Schena and Arrayit lied to investors to give them a false sense of credibility, paid illegal kickbacks to marketers to run deceptive plans about the accuracy of its tests, and submitted false claims to Medicare and private insurers for medically unnecessary allergy testing.  DOJ

August 30, 2023

Lompoc Valley Medical Center (LVMC) has agreed to pay $5 million to resolve allegations of causing false claims to be submitted to California’s Medicaid program.  Under the Patient Protection and Affordable Care Act (ACA), Medi-Cal received federal funds to expand coverage to previously uninsured adults.  However, LVMC knowingly claimed and received payments from the government for services that were duplicative, not reimbursable, or not priced at fair market value.  CA AG

August 18, 2023

A doctor who defrauded California’s Medicaid program of over $20 million has been sentenced to 5 years in jail, ordered to pay $2.3 million in restitution, and forced to surrender his medical license.  Mohamed Waddah El-Nachef had pleaded guilty to prescribing medically unnecessary anti-psychotics, HIV medications, and opioids to over a thousand Medi-Cal beneficiaries, many of whom then sold the drugs for cash.  CA AG

August 18, 2023

The owner and operator of Georgia-based LabSolutions LLC has been sentenced to 27 years in prison for submitting over $463 million in medically unnecessary genetic and other laboratory tests derived from illegal kickbacks.  Minal Patel allegedly paid kickbacks to telemarketing companies to talk Medicare beneficiaries into getting the tests, then paid kickbacks to telemedicine doctors who signed orders for the tests without ever speaking to beneficiaries to determine need.  As a result of these fraudulent actions, Medicare paid over $187 million in reimbursement, with Patel receiving over $21 million personally, between 2016 and 2019.  DOJ

August 4, 2023

Aspirar Medical Lab LLC and owner Pick Chay have agreed to pay almost $2 million to resolve allegations of defrauding the North Carolina Medicaid program.  The company allegedly paid two other companies for referring medically unnecessary urine drug tests to it, then submitted claims stemming from these illegal kickbacks to Medicaid.  NC AG

July 31, 2023

Martin’s Point Health Care Inc. in Maine has agreed to pay almost $22.5 million to resolve a lawsuit by a former manager in its Risk Adjustment Operations group, which alleged the health plan administrator defrauded Medicare over a three year period.  The former manager, Alicia Wilbur, alleged that Martin’s Point reviewed charts for their Medicare Advantage beneficiaries to identify additional diagnosis codes, then submitted those codes in claims to Medicare in order to increase reimbursements even though they were not properly supported by patient medical records.  For blowing the whistle on this misconduct, Wilbur will receive a $3.8 million award.  DOJ

July 11, 2023

The owner of one of California’s largest chains of pain management clinics has agreed to pay nearly $11.4 million to the federal government and the states of California and Oregon to settle allegations of defrauding Medicare and state Medicaid programs of millions of dollars.  A nearly four-year investigation by government data analysts found that Dr. Francis Lagattuta and his business, Lags Medical Clinics—which operates more than 20 facilities in California and Oregon—billed the healthcare programs for medically unnecessary tests and procedures that were provided to every patient as part of clinic protocols.  The investigation also found that patients who did not consent to such procedures had their pain medication reduced.  Furthermore, a respiratory therapist who was the spouse of an executive was recruited to interpret certain test results despite having no formal medical training.  In addition to the monetary penalty, Dr. Lagattuta is also barred from serving Medi-Cal beneficiaries for the next five years.  CA AG
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