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October 7, 2015

Kentucky-based nursing home pharmacy PharMerica Corp. agreed to pay $9.25 million to resolve allegations it violated the False Claims Act by soliciting and receiving kickbacks from pharmaceutical manufacturer Abbott Laboratories in exchange for promoting the anti-epileptic prescription drug Depakote for nursing home patients.  The settlement is part of the continuing fallout of the $1.5 billion settlement Abbott entered into with the government in May 2012 to resolve Abbott’s liability under the False Claims Act for alleged kickbacks to nursing home pharmacies, including PharMerica.  The settlement partially resolves allegations raised in two whistleblower lawsuits brought by former Abbott employees Richard Spetter and Meredith McCoyd under the qui tam provisions of the False Claims Act.  Ms. McCoyd will receive a whistleblower award of $1 million from the federal share of the settlement amount. Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Multiple Whistleblowers and First-to-File, Off-Label and Unapproved Use, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

October 7, 2015

Phoenix-based Serenity Hospice and Palliative Care agreed to pay $2.2 million to resolve allegations it violated the False Claims Act by submitting false bills to Medicare for hospice services.  In addition, Ruth Siegel, a former nurse and the founder and former president of Serenity, agreed to be excluded from Medicare, Medicaid, and all other federal health care programs for five years.  The allegations originated in a whistleblower lawsuit filed by Cheryl Sifford under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be-determined whistleblower award from the government’s recovery.  DOJ (AZ)

Tagged in: FCA Federal, Home Health and Hospice, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

October 2, 2015

Guardian Hospice of Georgia LLC, Guardian Home Care Holdings Inc.and AccentCare Inc. agreed to pay $3 million to resolve allegations they knowingly submitted false claims to Medicare for hospice patients who were not terminally ill.  The allegations originated in a whistleblower lawsuit filed by former Guardian employees Rose Betts and Jennifer Williams under the qui tam provisions of the False Claims Act.  Ms. Betts and Ms. Williams will receive a whistleblower award of approximately $510,000.  DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

October 1, 2015

Nurses’ Registry and Home Health Corporation and the Estate of its former owner, the deceased Lennie House, agreed to pay $16 million to resolve allegations that Nurses’ Registry, at the direction of Lennie House, violated the False Claims Act by fraudulently billing Medicare for medically unnecessary home health services and for services tainted by kickbacks provided by the company and House to local physicians and others who referred patients to Nurses’ Registry.  According to the government, Nurses’ Registry falsified medical records to make it appear as if patients had a medical need for skilled nursing or therapy services, or appear as if the patients were homebound.  In addition to billing Medicare for unnecessary or non-reimbursable home health services, Nurses’ Registry and House provided tickets to athletic events and concerts, and provided other things of value, to doctors and referral sources in order to induce or reward patient referrals.  The allegations originated in a whistleblower lawsuit filed by former employees Alisia Robinson-Hill and David Price under thequi tam provisions of the False Claims Act.  They will receive a yet-to-be-determined whistleblower award from the settlement proceeds.  DOJ (KY)

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

October 1, 2015

Strata Pathology Laboratory, Inc. (known as StrataDx) agreed to pay $558,793 to resolve allegations it violated the False Claims Act by inducing physicians to refer Medicare and Medicaid patients to Strata by paying kickbacks in the form of sham consulting fees and providing unlawful discounts to physicians.  According to the settlement agreement, Strata acknowledged paying consulting fees to two referring physician practices that did not provide consulting services in exchange.  Strata also acknowledged entering into “account billing” arrangements with seven referring physician practices that facilitated fee-splitting between the parties.  The allegations originated in a whistleblower lawsuit filed by a former Strata employee under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from a portion of the government’s recovery.  DOJ (MA)

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

September 29, 2015

Juan Carlos Delgado and Nereyda Infante, who owned and operated several Orlando-based health care clinics under variations of the name Prestige Medical, were sentenced to five years in prison and to pay $1,520,850 in restitution and forfeit $1,520,850 for their role in a $2.4 million health care fraud scheme.  According to admissions made in connection with their guilty pleas, between February 2012 and September 2014, the defendants fraudulently billed Medicare on behalf of the Prestige clinics for services never provided and for medications not prescribed or administered.  In particular, Delgado and Infante admitted to billing Medicare for pentostatin, an expensive anticancer chemotherapeutic medication used to treat Leukemia, despite never administering the drug.  DOJ

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

September 29, 2015

Delaware-based St. Francis Hospital agreed to pay roughly $4 million to the US and $200,000 to the State of Delaware to resolve charges it violated the False Claims Act by improperly billing Medicare and Medicaid for patients admitted into its inpatient rehabilitation unit in Wilmington, Delaware between 2007 and 2010, when admission was not medically necessary and/or the services provided did not fully qualify for reimbursement.  The settlement agreement also resolves separate allegations that St. Francis employed an individual who was excluded from participating in any Federal health care programs.  DOJ (DE)

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

September 28, 2015

American Access Care Holdings, LLC agreed to pay $3,594,791 to resolve allegations it violated the False Claims Act by improperly billing Medicare and Medicaid for multiple percutaneous transluminal angioplasties performed during the same patient encounter and improperly submitting claims to Medicare and Medicaid for procedures performed during follow-up visits that were not medically necessary.  The conduct addressed by the settlement occurred prior to AAC’s merger with Fresenius Vascular Care, Inc. in October 2011. DOJ (CT)

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

September 24, 2015

Elizabeth Kressin agreed to pay $62,349 to resolve allegations she violated the False Claims Act by improperly billing the Medicaid system for medically unnecessary chiropractic procedures and for the treatment of conditions for which payment is not allowed, including bed wetting, colic and ear infections.  DOJ (Iowa)

Tagged in: Chiropractic, FCA Federal, Medicaid,

September 21, 2015

Non-profit healthcare organization Adventist Health System agreed to pay $115 million to settle allegations it violated the False Claims Act by maintaining improper compensation arrangements with referring physicians and by miscoding claims.  The allegations originated in two whistleblower lawsuits filed by former Adventist hospital employees Michael Payne, Melissa Church and Gloria Pryor under the qui tam provisions of the False Claims Act.  The will receive a yet-to-be-determined whistleblower award from the government’s recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Medical Billing Fraud, Multiple Whistleblowers and First-to-File, Whistleblower Case, Whistleblower Rewards,

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