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October 22, 2020

Jerry Taylor of North Carolina has been sentenced to five years in prison and ordered to pay more than $6.1 million in restitution for his role in a $9.4 million fraud scheme targeting North Carolina’s Medicaid program.  Along with his brother Tony and co-conspirators in Ohio and New York, Taylor submitted claims for behavioral health services benefiting local at-risk youth that were purportedly performed at companies he owned and operated with his brother, but that were in reality not actually performed or misrepresented in the claims.  In addition to defrauding Medicaid, Taylor also evaded taxes by failing to report more than $1.6 million in reimbursements in 2016 and 2017.  For those charges, Taylor will pay over $346,000 to the IRS.  USAO WDNC

October 19, 2020

Utah-based medical device manufacturer, Merit Medical Systems Inc., has agreed to pay $18 million to multiple states to settle allegations of paying illegal kickbacks to healthcare providers and causing false claims to be submitted to Medicaid.  In order to induce sales of its embolotherapeutic devices—which are used to treat arteriovenous malformations, hypervascular tumors, and symptomatic uterine fibroids—Merit allegedly provided doctors, medical practices, and hospitals with millions of dollars in free advertising, educational grants, and practice support.  NC AG

October 14, 2020

Medical device maker Merit Medical Systems Inc. will pay $18 million to resolve claims first brought by a whistleblower under the False Claims Act that the company paid unlawful kickbacks to doctors and hospitals to induce them to use MMSI’s EmboSphere and QuadraSphere devices for embolization procedures.  MMSI was alleged to have offered hospitals and providers with millions of dollars in free advertising assistance, “educational” grants, and other services based on the providers’ past sales and to induce future sales.  The whistleblower, Charles J. Wolf, M.D., who will receive $2.65 million, was the Chief Compliance Officer for the company; according to DOJ, he repeatedly warned MMSI that its practices violated the Anti-Kickback Statue.  DOJ; USAO NJ

October 8, 2020

CHS/Community Health Systems Inc. will pay $5 million to resolve the claims of 28 states related to a data breach that affected over six million patients, exposing their names, birthdates, social security numbers, and other information.  CHS also agreed to take undertake specific measures to help keep patients’ information secure.  NC

October 2, 2020

Pharmatech, Inc. and its CEO and founder Tuan Pham will pay over $3 million to settle allegations in a case initiated as a qui tam action under the False Claims Act.  The government alleged that defendants violated the Anti-Kickback Statute by paying a medical clinic, Imperial Valley Wellness, a per-specimen fee to induce it to refer orders for laboratory drug-testing to Phamatech which were subsequently billed to Medicare.  Many of the tests were also alleged to be not medically necessary. The whistleblower, former Pharmatech employee John Polanco, will receive over $500,000 from the settlement.  USAO SD Cal.

October 2, 2020

Advanced Pain Management Holdings, Inc. and its subsidiaries will pay $1 million to resolve claims brought by a whistleblower under the False Claims Act.  Defendants, which run ambulatory surgical centers, were alleged to have violated the Anti-Kickback Statute by improperly gifting incentive stock shares to non-employee physicians allegedly as a reward for past and anticipated referrals to APMH facilities, and by paying those physicians “medical director” fees tied to the volume of procedures at APMH facilities, without proper documentation of the agreement.  In addition, defendants were alleged to have performed unnecessary confirmatory urine drug testing on patients.  USAO ED WI

October 2, 2020

Two New York-based physical therapy providers have agreed to pay $4 million to resolve whistleblower-brought allegations of violating the False Claims Act by improperly billing multiple government healthcare programs, including Medicare, Medicaid, the Federal Employees’ Compensation Act Program (FECA), and the Federal Employees’ Health Benefits Program (FEHBP).  The alleged misconduct by Williamsburg Physical Therapy, P.C., Euro Physical Therapy, P.C., owners Alex and Diana Klurfeld, and management company First Plus Services, Inc. occurred between 2008 to 2018, and involved billing for physical therapy services provided or supervised by someone other than the licensed therapist listed on claims, as well as backdating services after treatment authorizations had expired.  USAO EDNY

September 29, 2020

Laredo optometrist David Mora will pay $3.23 million and enter into a corporate integrity agreement to resolve claims that he submitted false claims to Medicare between 2013 and 2019.  Mora allegedly billed for services including punctal plug insertion, sensorimotor testing, vision therapy, and amniotic membrane placement, where the patient’s condition did not warrant the service as medically necessary or reasonable.  USAO SD TX

September 28, 2020

Lakeway Regional Medical Center, LLC, together with affiliated parties Surgical Development Partners LLC, Surgical Development Partners of Austin Enterprises LLC, G. Edward Alexander, Frank Sossi, and John Prater, will pay $15.3 million to resolve allegations under the False Claim Act arising from the development of the hospital.  Defendants were alleged to have made numerous false statements in applying for a federally-insured mortgage loan for construction of the hospital, including overstating physician support for the hospital and understating other credit risks.  Specifically, while some investors had requested refunds, defendants delayed making those refunds in order to overstate cash on hand, and, after the mortgage funds were obtained, defendants distributed them in contravention of FHA requirements.  The hospital later defaulted on the loan. The government previously settled with other defendants.  DOJ 

September 28, 2020

Lakeway Regional Medical Center, LLC will pay $1,119,177 to resolve allegations that the hospital submitted false claims to the Medicare and Medicaid programs in the form of claims for payment for services that were based on referrals from doctors offered investment in a joint venture to purchase and then lease the hospital back to LRMC.  The government alleged that such an arrangement was unlawful under the Anti-Kickback Statute.  The case was initiated by a qui tam complaint filed by Dr. Robert Van Boven and Sharon Van Boven.  USAO WD TX
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