Archive

September 7, 2016

Medical equipment supply companies U.S. Healthcare Supply LLC and Oxford Diabetic Supply Inc., along with their owners and presidents, agreed to pay more than $12.2 million to resolve allegations that they violated the False Claims Act by making unsolicited calls to Medicare beneficiaries to sell them durable medical equipment.  According to the government, the two companies created a fictitious company called Diabetic Experts Inc., which they used to make the unsolicited calls, and then submitted claims to Medicare for the equipment they sold in violation of the Medicare Anti-Solicitation Statute.  Whistleblower Insider

September 7, 2016

Clinical psychologists Beverly Stubblefield and John Teal pleaded guilty for their involvement in a fraudulent psychological testing scheme that preyed upon Medicare recipients living in nursing homes throughout the Southeastern United States.  Stubblefield and Teal practiced as clinical psychologists at Nursing Home Psychological Services, Inc. and Psychological Care Services, Inc. and they admitted their companies billed Medicare for psychological tests to nursing home residents throughout Mississippi, Louisiana, Florida and Alabama which were not medically necessary or not provided at all.  They further admitted they repeatedly tested the same nursing home residents even though some were incapacitated and could not meaningfully participate in testing.  DOJ

August 31, 2016

Clear Vue Eye Center and its owner, Dr. Monique Barbour, agreed to pay $1 million to resolve allegations that they violated the False Claims Act by overbilling Medicare for patient visits at nursing homes and assisted living facilities, and for billing for procedures purportedly performed while Dr. Barbour was out of the country.  According to the government, Dr. Barbour billed excessively for patient visits, billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period.  Records reviews show that many of the procedures billed were medically unnecessary with little patient benefit and that Dr. Barbour billed procedures at the most profitable rates regardless of the procedure’s proper billing code.  The allegations originated in a whistleblower lawsuit brought by former Clear Vue employee Lori Moore under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $200,000 from the proceeds of the government's recovery.  DOJ (SDFL)

August 24, 2016

New York hospitals Beth Israel Medical Center (d/b/a Mount Sinai Beth Israel), St. Luke’s-Roosevelt Hospital Center (d/b/a Mount Sinai St. Luke’s) and Mount Sinai Roosevelt, and Continuum Health Partners, agreed to pay $2,950,000 to settle charges that they violated the federal and New York False Claims Act by willfully delaying repayment of over $800,000 in Medicaid overpayments that resulted from improper claims submitted because of a software error.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery.  DOJ (SDNY)

August 17, 2016

Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital and affiliated entities including a related pain clinic, Lehigh Valley Pain Management, agreed to pay $690,441 to resolve allegations they violated the False Claims Act by submitting false health care billings for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising.  The allegations originated in whistleblower lawsuit filed Margaret Reynard under the qui tam provisions of the False Claims Act.  Ms. Reynard will receive a whistleblower award of roughly $124,000 from the proceeds of the government's recovery.  DOJ (EDPA)

August 17, 2016

Florida urologist Robert A. Scappa agreed to pay $250,000 to resolve allegations that he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary.  During the relevant time period, Scappa was a urologist practicing as part of Scappa Urology, which was a division of 21st Century Oncology, LLC., a nationwide provider of integrated cancer care services.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former medical assistant who worked for Dr. David Spellberg of Naples Urology Associates, which was also a division of 21st Century Oncology.  The whistleblower will receive an award of $37,500 from the government's recovery.  This amount is in addition to a $3.2 million share she will receive as the result of the $19.75 million settlement previously reached with 21st Century Oncology.  DOJ (MDFL)

August 15, 2016

Miami resident Ramon Collado Gonzalez pleaded guilty to participating in a $4.2 million home health care fraud scheme.  As part of his guilty plea, Gonzalez admitted being recruited by Mildrey Gonzalez and Milka Alfaro, the owners of Miami health care agency Golden Home Health Care Inc., to falsely represent himself to be Golden’s owner so they could improperly obtain funds from Medicare.  DOJ

August 24, 2016

New York and the Justice Department announced that three hospitals in the Mount Sinai Health System are paying a total of $2.95 million to resolve allegations that the hospitals knowingly retained over $844,000 in overpayments made by Medicaid in violation of the federal and New York False Claims Acts. Knowing retention of an overpayment from the government for more than sixty days is known as a “reverse false claim” and is a violation of both federal and state false claim acts. The entities involved include Mount Sinai Beth Israel (“Beth Israel”) (formerly Beth Israel Medical Center), Mount Sinai St. Luke’s (“St. Luke’s”) (formerly St. Luke’s Hospital) and Mount Sinai Roosevelt (“Roosevelt”) (formerly Roosevelt Hospital) (together, the “Hospitals”) – and the Hospitals’ former partnership group, Continuum Health Partners, Inc. (“Continuum,” and together with the Hospitals, “Defendants”). As part of the settlements, Defendants admitted that, beginning in 2009 due to a software compatibility issue, a coding error caused Defendants to submit claims for payment above and beyond what they had received from the managed care organization, and that Medicaid paid these claims as a secondary payor. In September 2010, the New York Office of the State Comptroller brought to Continuum’s attention a small number of these claims, and Defendants admitted that in late 2010 they were made aware of the coding error. NY

August 22, 2016

New York announced a settlement with HealthNow, New York, Inc., after an investigation uncovered the wrongful denial of thousands of claims for outpatient psychotherapy and more than one hundred claims for nutritional counseling for eating disorders. The wrongful denials totaled more than $1.6 million in patient claims. Under the agreement, the Buffalo-based company, a not-for profit health service corporation providing health care coverage for approximately 573,700 New Yorkers (including 291,000 who are enrolled in commercial health plans), will pay members for the wrongfully denied claims, revise its policies, and will eliminate a company policy that subjected all psychotherapy claims to review after a member’s 20th visit. Attorney General Schneiderman’s Health Care Bureau launched an investigation in 2015 into HealthNow’s administration of behavioral health benefits following the receipt of consumer complaints. The complaints alleged that HealthNow had improperly denied coverage for treatments by requiring that all outpatient behavioral health visits be preauthorized after the first 20 visits per year, and by excluding coverage for nutritional counseling for eating disorders. NY

August 22, 2016

Two Florida companies have been ordered to pay $17 million for deceptively marketing and billing for medications and services relating to the treatment of erectile dysfunction at an unlicensed medical clinic in Framingham, Massachusetts announced. The judgment, ordered by the Suffolk Superior Court, permanently prohibits Florida Men’s Medical Clinic, LLC (FMMC) and Men’s Medical Clinic, LLC (MMC) from operating unlicensed medical clinics in Massachusetts or deceptively marketing any medication or medical service relating to the treatment of erectile dysfunction in the state. Under the judgment, the two companies are also ordered to pay, between them, in excess of $17 million, with $6.3 million for restitution to Massachusetts consumers and the remainder in payments to the Commonwealth, including civil penalties. The companies have represented that they have ceased operations, and recovery of the amounts they are ordered to pay is uncertain. MA