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August 11, 2016

Tracy Richardson Brown, the owner of New Orleans-based medical equipment supply company, Psalms 23 DME LLC was sentenced to 80 months in prison and to pay roughly $2 million in restitution for directing a scheme to defraud Medicare out of more than $3.3 million.  According to the evidence introduced at trial, Brown paid patient recruiters for the names and billing information of Medicare beneficiaries and used it to bill Medicare for power wheelchairs and various knee, elbow and back braces.  However, the vast majority of these patients did not need, and often did not receive or even want, this equipment.  DOJ

Tagged in: Healthcare Fraud, Medical Devices and DME, Medicare,

August 8, 2016

The Estate of Dr. Kenneth Michael Rice and Texas-based physician practice management group UMC Physicians agreed to pay roughly $3.3 million to settle charges of violating the False Claims Act for billing Medicare/Medicaid for in-person evaluation and management services at the higher physician fee rate when the services were not provided by physicians.  They also allegedly billed normal evaluation and management services to Medicare at the higher critical-care rate.  DOJ (NDTX)

Tagged in: FCA Federal, Improper Medical Personnel, Provider Fraud, Upcoding,

August 5, 2016

A series of anesthesia businesses collectively known as Sweet Dreams Nurse Anesthesia agreed to pay roughly $1 million to settle charges they violated the False Claims Act, Anti-Kickback Statute and Georgia False Medicaid Claims Act by paying unlawful kickbacks to health care providers for referrals.  According to the government, one alleged scheme involved Sweet Dreams’ provision of free anesthesia drugs to ambulatory surgery centers (ASCs) in exchange for granting Sweet Dreams an exclusive contract to provide anesthesia services at those ASCs.  A second alleged scheme allegedly involved the agreement of an affiliate of Sweet Dreams to fund the construction of an ASC in exchange for contracts for Sweet Dreams’ selection as the exclusive anesthesia provider.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Adam Nauss.  He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (MDGA)

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Medicaid, Medicare, Whistleblower Case, Whistleblower Rewards,

August 1, 2016

St. Joseph’s Hospital Health Center agreed to pay $3.2 million to resolve allegations it violated the federal False Claims Act and New York False Claims Act by billing the state Medicaid program for mental health services provided by unqualified staff.  Specifically, the government alleged that St. Joseph's billed Medicaid for mobile-crisis outreach services that failed to comply with Comprehensive Psychiatric Emergency Program (CPEP) staffing requirements.  The allegations originated in a whistleblower lawsuit filed by registered nurse Catherine Lembo under the qui tam provisions of the federal and New York False Claims Acts.  Ms. Lembo will receive a whistleblower award of $560,000 from the proceeds of the government’s recovery.  Whistleblower Insider

Tagged in: FCA Federal, FCA State, Hospital Fraud, Improper Medical Personnel, Medicaid, Whistleblower Case, Whistleblower Rewards,

August 1, 2016

New York and the Justice Department announced that St. Joseph’s Hospital Health Center (St. Joseph’s) will pay $3.2 million to resolve allegations that it violated the federal and New York False Claims Act by presenting false claims for payment to the state Medicaid program for mental health services rendered by unqualified staff. settlements resolve allegations that St. Joseph’s knowingly presented false claims for payment to Medicaid for mobile-crisis outreach services rendered from January 1, 2007 through February 29, 2016 by personnel who failed to satisfy the basic CPEP staffing requirements. By submitting claims for payment to Medicaid without disclosing that its CPEP staff failed to meet the regulatory staffing requirements, and by accepting payment for these claims, the governments allege that St. Joseph’s misrepresented its compliance with mental health staffing requirements that are central to the provision of counseling services and, by doing so, violated the False Claims Act. As part of the settlements, St. Joseph’s admits that it was improper to have conducted mobile crisis outreach visits without a member of its CPEP professional staff present and then bill Medicaid for such services. NY

Tagged in: FCA Federal, FCA State, Hospital Fraud, Improper Medical Personnel, Medicaid,

July 29, 2016

A judgment for $4,752,101.50 was entered against LXE Counseling, LLC and its owner Lexie Darlene George (a/k/a Lexie Darlene Batchelor) for violations of the False Claims Act, the Oklahoma Medicaid False Claims Act and the Oklahoma Medicaid Program Integrity Act.  Specifically, LXE and Batchelor were found to have submitted claims to Oklahoma Medicaid for services that were, among other things: provided by unqualified persons; based on falsified time and service records; double billed; unauthorized or not provided.  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 whistleblower award from the proceeds of the government's recovery.  DOJ (WDOK)

Tagged in: FCA Federal, FCA State, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

July 29, 2016

Syed Imran Ahmed, a New York surgeon who practiced at hospitals in Brooklyn and Long Island, was convicted of submitting millions of dollars in fraudulent claims to Medicare.  According to the evidence, Ahmed submitted more than $25 million in false claims to Medicare for incision-and-drainage and wound debridement surgeries he did not perform.  DOJ

Tagged in: Medical Billing Fraud, Medicare, Provider Fraud,

July 28, 2016

South Carolina hospital Lexington County Health Services District Inc. (d/b/a Lexington Medical Center) agreed to pay $17 million to resolve allegations it violated the False Claims Act and the Physician Self-Referral Law (known as the Stark Law) by maintaining improper financial arrangements with 28 physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Lexington Medical Center physician Dr. David Hammett.  He will receive a whistleblower award of roughly $4.5 million from the proceeds of the government’s recovery.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

July 27, 2016

Deremedx Dermatology, P.C. (d/b/a Dermatique) and its owner Dr. Barry A. Solomon agreed to pay roughly $300,000 to resolve charges they violated the False Claims Act repeatedly billing Medicare and Medicaid for services performed as if Solomon were supervising the procedures even though he was not in the office and was in some cases out of the country.  Solomon also billed for so-called “impossible days” in which he submitted claims for more hours than he could have possibly worked.  The allegations originated in a whistleblower lawsuit filed by Diane Vitale under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (EDNY)

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Whistleblower Case, Whistleblower Rewards,

July 27, 2016

The University of Pittsburgh Medical Center, together with the University of Pittsburgh Physicians, UPMC Community Medicine, Inc., and Tri-State Neurosurgical Associates-UPMC, Inc., agreed to pay roughly $2.5 million to settle charges they violated the False Claims Act by submitting false claims to Medicare.  Specifically, the government alleged that certain neurosurgeons employed by UPMC submitted claims for assisting with or supervising surgical procedures performed by other surgeons, residents, fellows, or physician assistants, when those neurosurgeons did not participate in the relevant surgeries to the degree required.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (WDPA)

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicare, Whistleblower Case, Whistleblower Rewards,

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