Archive

May 20, 2016

New Jersey announced that a chiropractor from Morris County pleaded guilty to taking more than $250,000 in illegal kickbacks from doctors and other individuals in return for referring patients to their practices, clinics and medical imaging centers. Dr. Alexander Dimeo, 61, of Budd Lake, N.J., and Fort Myers, Fla., pleaded guilty to two separate accusations before Superior Court Judge Michael A. Toto in Middlesex County. Dimeo retired last year, but he formerly operated Passaic Chiropractic & Therapy Center PC in Passaic. In pleading guilty, Dimeo admitted that between 2009 and 2015, he received approximately $254,500 in illegal kickbacks for patient referrals. NJ

May 12, 2016

Kentucky anesthesiologist Jaime Guerrero was sentenced to 100 months in prison for his role in the unlawful distribution of controlled substances, including the prescription opioid hydrocodone without a legitimate medical purpose.  Guerrero also agreed to pay $827,000 in victim restitution to nine health care benefit programs.  He also pleaded guilty to multiple counts of unlawful distribution or dispensing of controlled substances, health care fraud, conspiracy and money laundering.  DOJ

May 9, 2016

CA oncologist Dr. John F. Kiraly and his wife Rena Kiraly, who served as the doctor’s office administrator, have paid $300,000 to settle allegations that they violated the False Claims Act by improperly billing Medicare for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical distributor.  Specifically, the Kiralys purchased chemotherapy drugs from Warwick Healthcare Solutions Inc., also known as Richards Pharma, a former United Kingdom-based drug distributer that distributed non-FDA approved drugs throughout the United States.  DOJ (EDCA)

May 13, 2016

A Somerville-based ambulance services provider has been sued for allegedly overbilling the state’s Medicaid program (MassHealth) for more than $600,000 in ambulance services that reflected a higher level of care than was actually provided. The complaint against Cataldo Ambulance Service, Inc. (Cataldo), filed on Thursday in Suffolk Superior Court, alleges that from 2005 to November 2015, Cataldo billed MassHealth for Emergency Advanced Life Support (ALS) services when, in fact, the patient’s condition at the scene only required, and the patient only received, Emergency Basic Life Support (BLS) services. Cataldo provides a variety of transportation services, including emergency ambulance services, throughout the Greater Boston area. According to the complaint, Cataldo’s inappropriate billing practices persisted despite being notified that, in many instances, the patient’s condition and the services rendered were insufficient to justify billing at an ALS level. MA

May 6, 2016

The Trustees of the University of Pennsylvania, on behalf of its operating divisions, including the University of Pennsylvania Health System (UPHS), agreed to pay roughly $76,000 to settle charge of violating the False Claims for the alleged submission of false home health care billings to the Medicare program.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  DOJ (EDPA)

May 5, 2016

The City of New York agreed to pay $4.3 million to settle charges of violating the False Claims Act through the New York City Fire Department's receipt of reimbursements for claims for emergency ambulance services that did not meet Medicare’s medical necessity requirement.  This matter was brought to the attention of the U.S. Attorney’s Office through a voluntary disclosure by the City.  DOJ (SDNY)

May 3, 2016

Virginia-based Agape Health Management, Inc., which operates under the name Agape Adult Day Healthcare Center, agreed to pay $385,917 to settle charges of violating the False Claims Act by submitting false claims for transportation services purportedly provided to Virginia Medicaid recipients that were not present or transported to the Agape facility on the claimed dates of service.  DOJ (EDVA)

April 29, 2016

Hollister Inc., a manufacturer of disposable health care products, and Byram Healthcare Centers Inc., a supplier of medical products, agreed to respectively pay roughly $11.4 million and $9.4 million to resolve allegations they violated the False Claims Act through an illegal kickback scheme.  According to the government, Hollister paid kickbacks to Byram in return for marketing promotions, conversion campaigns and other referrals of patients to Hollister’s ostomy and continence care products.  The government claimed that Byram also received kickbacks from three other manufacturers of ostomy and continence care products, namely Coloplast Corp., Montreal Ostomy and Safe N’ Simple.  The allegations originated in a whistleblower lawsuit filed by two former employees and one current employee of Coloplast under the qui tam provisions of the False Claims Act.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ

April 28, 2016

California doctor Gary J. Ordog pleaded guilty to submitting more than $2.4 million in fraudulent claims to Medicare.  Ordog, who purported to be a physician specializing in toxicology, admitted submitting false claims to Medicare for purported visits with Medicare beneficiaries, when in fact those visits never actually occurred, including on dates when Ordog was out of the country.  He also admitted to billing for services provided to beneficiaries who were deceased and for services totaling more than 24 hours in one day.  DOJ

April 27, 2016

Pharmaceutical giants Wyeth and Pfizer, Inc. agreed to pay $784.6 million to resolve allegations that Wyeth violated the False Claims Act by reporting to the government false prices on two of its proton pump inhibitor (PPI) drugs, Protonix Oral and Protonix IV.  Under the state Medicaid programs, drug companies must provide Medicaid rebates based on the best prices they offer other customers.  According to the government, Wyeth hid from Medicaid bundled discounts it provided to thousands of hospitals across the country on Protonix Oral and Protonix IV.  By failing to report these bundled discounts, Wyeth allegedly avoided paying hundreds of millions of dollars in rebates.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Lauren Kieff, a former hospital sales representative for AstraZeneca and William St. John LaCorte, a physician practicing in New Orleans.  They will collectively receive a whistleblower award of roughly $98 million from the proceeds of the federal and state settlements.  Whistleblower Insider