Archive

June 1, 2016

Florence Bikundi and her husband Michael D. Bikundi Sr., owners of home care agency Global Healthcare Inc., were sentenced to prison for 10 years and 7 years, respectively, for health care fraud, money laundering, and other charges stemming from a scheme in which they and others defrauded the District of Columbia Medicaid program of over $80 million.  They were also ordered to forfeit over $11 million seized from 76 bank accounts; their $1 million residence; $73,000 in cash seized from their residence and five luxury vehicles.  The court also imposed a forfeiture money judgment of roughly $40 million and ordered them to pay roughly $80 million in restitution to D.C. Medicaid.  The government’s evidence showed the Bikundis led a scheme to bill Medicaid for services that were not fully provided, recruiting others, including family members, into the scam and creating fraudulent paperwork to hide the illegal activity.  DOJ

June 1, 2016

Dr. Jonathan Oppenheimer, former owner and CEO of Nashville drug testing laboratory Prost-Data, Inc. (d/b/a OURLab), OPKO Health, Inc., and OPKO Lab, have agreed to pay $9.35 million to resolve charges they violated the False Claims Act by providing illegal kickbacks in exchange for business.  According to the government, Dr. Oppenheimer and OURLab made donations toward electronic health records (EHR) systems purchased by their client physician practices that fell outside the restrictions set forth in the Anti-Kickback Statute EHR safe harbor and the Stark EHR exception.  The allegations originated in a whistleblower lawsuit filed by a former OURLab employee under the qui tam provisions of the False Claims Act.  The whistleblower will receive a whistleblower award of $1.683 million from the proceeds of the government's recovery.  DOJ (MDTE)

May 31, 2016

Newark, New Jersey-based Saint Michael’s Medical Center Inc. agreed to pay $450,000 to resolve allegations it violated the False Claims Act by falsely billing Medicare and Medicaid for medically unnecessary cardiac procedures.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act.  DOJ (DNJ)

May 27, 2016

Medical device manufacturer Paradigm Spine agreed to pay $585,000 to resolve allegations it violated the False Claims Act by marketing the company’s coflex-F® device for surgical uses that were not approved by the FDA.  The settlement further resolves allegations that Paradigm caused false claims by giving false recommendations on how to code health claims for procedures involving the company’s coflex® device.  The allegations originated in a whistleblower lawsuit filed by Chris Coyle, a former Paradigm Spine sales representative, under the qui tam provisions of the False Claims Act.  Mr. Coyle will receive a whistleblower award of approximately $105,300 from the proceeds of the government's recovery.  DOJ (DMD)

May 27, 2016

Carlos Rodriguez Nerey, the owner and president of Miami-area consulting and staffing company Nerey Professional Services Inc., was sentenced to 60 months in prison (and ordered to pay roughly $2.4 million in restitution) for his role in a $2.3 million Medicare fraud scheme.  According to evidence presented at trial, Nerey was involved in a conspiracy to accept kickbacks in return for referring Medicare beneficiaries to Mercy Home Care Inc. and D&D&D Home Health Care Inc. to serve as patients, including those who did not qualify for home health care services.  DOJ

June 8, 2016

New Jersey announced that a Burlington County medical device distributor was charged with stealing more than $100,000 in insurance payments intended for two companies that made and marketed a device to clear patients’ airways. Loetta Karen Edwards, 46, owner of Edwards Medical DME, LLC, (Edwards Medical) in Cinnaminson, was indicted on one count of second-degree theft by failure to make required disposition of property received. Edwards was a local distributor of the “Frequencer,” a Canadian-made medical device that helps clear airways in patients with cystic fibrosis and chronic obstructive pulmonary disease. According to prosecutors, Edwards would order the devices on behalf of individuals who paid for them through their insurance companies. Prosecutors say Edwards would then process the insurance claims for the devices and receive the payments. She would then remit a portion of the money to the device manufacturer, Dymedso, Inc., and a portion to Dymedso’s Ohio-based sales representative, Clinical Technology. NJ

May 26, 2016

New York announced that it has entered into a settlement agreement with Vascuscript, Inc., d/b/a Mobile Pharmacy Solutions, to resolve allegations that it billed Medicaid for prescriptions which were written by an excluded Medicaid Provider. The Attorney General’s investigation determined that from April 21, 2010, through January 25, 2013, Vascuscript, Inc. submitted and received payment on approximately 4,600 claims to Medicaid for prescriptions that were written by Dr. Mikhail Strutsovskiy. The Department of Health had previously excluded Dr. Strutsovskiy from the Medicaid program, rendering prescriptions written by him ineligible for Medicaid reimbursement. Before filling a prescription, pharmacies are required under Medicaid billing rules to first ascertain whether the prescriber’s services are eligible for reimbursement. Because Vascuscript did not do so, it filled and delivered the prescriptions written by Dr. Strutsovskiy that were not eligible for Medicaid reimbursement. NY

May 24, 2016

California filed a lawsuit against Johnson & Johnson (J&J) for false advertising and deceptive marketing of its surgical mesh products for women. The complaint alleges that J&J neglected to inform both patients and doctors of possible severe complications and misrepresented the frequency and severity of risks. California co-led a multistate investigation, including 46 states and the District of Columbia, into J&J’s surgical mesh products for women, and is seeking injunctive relief and monetary penalties to ensure that J&J stops its deceptive practices. The suit further claims that J&J knew about potential risks and side effects prior to the launch of their mesh products, yet omitted that information from educational and marketing materials provided to doctors and patients. CA, WA

May 20, 2016

Hospicio La Paz, Inc. agreed to pay $2.5 million to settle charges of violating the False Claims Act in connection with approximately $1.5 million in questionable billings it submitted for payment to the Medicare Part A program.  DOJ (D.PR)

May 18, 2016

Missouri physician Randall E. Meyer pleaded guilty to (and agreed to pay roughly $75,000) violating the False Claims Act.  Meyer, a surgeon with Central Missouri Cardiology, P.C., admitted claiming the percentage of patients’ lesions and stenosis in their arteries was 70 percent or greater when it was substantially less.  The health care benefit programs would not have reimbursed claims if the programs had known Meyer was inflating the percentage of patient lesion and stenosis.  DOJ (W.D.MO)