Archive

September 18, 2015

Mary Talaga, the primary medical biller at Medicall Physicians Group Ltd., a Chicago-area visiting physician practice, was sentenced to 45 months in prison and to pay $1 million in restitution for her role in a $4 million health care fraud scheme.  The evidence at trial showed that Talaga and her co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely provided the service.  DOJ

September 15, 2015

North Broward Hospital District, operator of hospitals and other health care facilities in the Broward County, Florida area, agreed to pay $69.5 million to settle allegations it violated the False Claims Act by engaging in improper financial relationships with referring physicians.  According to the government, the hospital district provided compensation to nine employed physicians that exceeded the fair market value of their services violating both the Stark Statute and False Claims Act.  The allegations first arose from a whistleblower lawsuit filed by Dr. Michael Reilly under the qui tam provisions of the False Claims Act.  Dr. Reilly will receive a whistleblower award of roughly $12 million.  DOJ

September 11, 2015

A federal jury convicted Houston psychiatrist Sharon Iglehart of participating in a $158 million Medicare fraud scheme involving false claims for mental health treatment.  According to evidence presented at trial, from 2006 until June 2012, Iglehart and others engaged in a scheme to defraud Medicare by submitting, through Riverside General Hospital, approximately $158 million in false and fraudulent claims for partial hospitalization program services to Medicare beneficiaries who did not actually receive the services.  DOJ

September 10, 2015

Tennessee-based non-profit hospice care provider Alive Hospice, Inc.paid roughly $1.5 million to reimburse the government for alleged violations of the False Claims Act through overbilling of Medicare and TennCare for hospice services.  According to the government, Alive submitted claims to Medicare and TennCare for general inpatient hospice care for patients who did not qualify for that care.  The allegations originated in a whistleblower lawsuit filed by Linda Anderson, a triage nurse who previously worked for Alive, under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $263,197. Whistleblower Insider

September 4, 2015

Rick Brown, former president of Home Care America Inc., which managed the daily business operations of Medicall Physicians Group Ltd., was sentenced to 87 months in prison and to pay $1.3  million in restitution for his role in a $4 million health care fraud scheme.  Medicall is a physician practice that visited patients in their homes and prescribed home health care.  The evidence at trial showed that Brown and his co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely did so.  The evidence also showed that Brown and his co-conspirators billed Medicare for services never provided, including services rendered to patients who were deceased, services purportedly provided by medical professionals no longer employed by Medicall, and services purportedly provided by medical professionals who, based on billing records, worked over 24 hours per day. DOJ

September 4, 2015

Columbus Regional Healthcare System and Dr. Andrew Pippas agreed to pay more than $25 million to resolve allegations they violated the False Claims Act by submitting claims in violation of the Stark Law.  The settlement also resolves allegations that Columbus Regional and Pippas submitted claims for payment to federal health care programs that misrepresented the level of services they provided.  According to the government, between 2003 and 2013, Columbus Regional provided excessive salary and directorship payments to Pippas that violated the Stark Law.  The government further alleged Columbus Regional submitted claims to federal health care programs for services at higher levels than supported by the documentation.  The allegations first arose in two whistleblower lawsuits filed former Columbus Regional executive Richard Barker under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act.  Barker will receive a yet-to-be-determined whistleblower award.  DOJ

September 3, 2015

Genzyme Corporation, a wholly-owned biotechnology subsidiary of French pharmaceutical company Sanofi, agreed to resolve criminal charges it violated the Food, Drug and Cosmetic Act with regard to the unlawful distribution of the surgical device Seprafilm.  As part of the agreement, Genzyme agreed to admit to the facts underlying the charges and pay a monetary penalty of $32,587,439.  Whistleblower Insider

September 3, 2015

St. Joseph Hospice Entities, which consists of 13 hospice facilities in Mississippi, Louisiana, Texas and Alabama, and Patrick T. Mitchell, its majority owner and manager, agreed to pay $5,867,518 to resolve allegations they violated the False Claims Act by submitting false claims for delivery of continuous home care hospice services to patients who were not entitled to receive them.  The allegations originated in a whistleblower lawsuit filed by 3 former employees of the company under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $1 million.  DOJ

September 1, 2015

Discount department store chain KMART Corp., which operates approximately 780 in-store pharmacies throughout the US, agreed to pay $1.4 million to resolve allegations it violated the False Claims Act by using drug manufacturer coupons and gasoline discounts as improper Medicare beneficiary inducements.  According to the government, Kmart improperly influenced the decisions of Medicare beneficiaries to bring their prescriptions to Kmart pharmacies by permitting them to use drug manufacturer coupons to reduce or eliminate prescription co-pays that they otherwise would be obligated to pay, and by also offering them varying levels of discounts on the purchase of gasoline at participating gas stations.  The allegations originated in a whistleblower lawsuit filed by former Kmart pharmacist Joshua Leighr under the qui tam provisions of the False Claims Act.  Leighr will receive a whistleblower award of approximately $248,500.  DOJ

August 31, 2015

Laran Lerner, a Detroit-area physician who prescribed unnecessary controlled substances and billed for unperformed office visits and diagnostic testing, pleaded guilty for his role in a $5.7 million health care fraud scheme.  DOJ