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February 7, 2018

New York surgeon Syed Imran Ahmed was sentenced to 156 months in prison -- and ordered to pay roughly $7 million in restitution, forfeit roughly $7 million and pay a $20,000 fine -- for his role in a scheme that involved the submission of millions of dollars in false and fraudulent claims to Medicare. According to evidence presented at trial, Ahmed, who practiced at Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center in Brooklyn, Franklin Hospital in Valley Stream, and Mercy Medical Center in Rockville Centre, New York, billed the Medicare program for incision-and-drainage and wound debridement procedures that he did not perform. DOJ

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

February 6, 2018

Kentucky ENT physician Phillip B. Klapper, M.D., Patricia Klapper, and Phillip B. Klapper, P.S.C. agreed to pay roughly $2.8 million to settle claims they violated the False Claims Act by submitting claims under the Federal Employees’ Compensation Act which falsely indicated that audiological tests were performed by licensed and certified personnel  and/or the testing results were altered to enable some claimants to appear to have hearing losses. DOJ (WDKY)

Tagged in: FCA Federal, Medical Billing Fraud, Provider Fraud,

February 2, 2018

Memphis Operator, LLC (d/b/a Spring Gate Rehabilitation and Healthcare Center) agreed to pay $500,000 to settle claims of violating the False Claims Act for billing Medicare for services to residents of Spring Gate that were materially substandard, worthless and were provided in violation of certain essential requirements that the United States expects skilled nursing facilities to meet. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (WDTX)

Tagged in: FCA Federal, SNF, Whistleblower Case, Whistleblower Rewards,

January 31, 2018

Brooklyn-based home health care company Home Family Care, Inc. and its co-owner and president agreed to pay roughly $6.4 million to settle claims they violated the False Claims Act by billing Medicaid for home health care services the company did not provide to Medicaid recipients. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (EDPA)

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

January 30, 2018

Tampa’s largest ambulance providers AmeriCare Ambulance Service, Inc. and its sister company AmeriCare ALS, Inc. agreed to pay roughly $5.5 million to settle claims they violated the False Claims Act by billing Medicare for medically unnecessary ambulance transportation services. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former AmeriCare employee Ernest Sharp. He will receive a whistleblower award of roughly $1.15 million from the proceeds of the government’s recovery. DOJ (MDFL)

Tagged in: Ambulance, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

January 25, 2018

Primex Clinical Laboratories, LLC agreed to pay $3.5 million to settle claims it violated the False Claims Act and Anti-Kickbacks Statue by paying kickbacks in exchange for laboratory referrals for patient pharmacogenetic testing. The allegations originated by a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former sales reps Don Pyburn and David Choate. They will receive a whistleblower award of $754,000 from the proceeds of the government’s recovery. DOJ (NDTX)

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

January 24, 2018

Tennessee chiropractor Matthew Anderson agreed to pay $1.45 million to resolve allegations he violated the False Claims Act. Specifically, the government alleged that Anderson and his management company, PMC LLC, caused pharmacies to submit requests for Medicare and TennCare payments for pain killers dispensed based upon prescriptions written at the Cookeville Center for Pain Management, one of the pain clinics Anderson managed, which had no legitimate medical purpose. The government further alleged that Anderson caused four pain clinics he managed to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. The allegations originated in a whistleblower lawsuit filed by a former office manager for the Cookeville Center for Pain Management under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $246,500 from the proceeds of the government's recovery. DOJ

Tagged in: Chiropractic, FCA Federal, Lack of Medical Necessity, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

January 23, 2018

Drs. Aytac Apaydin and Stephen Worsham, urologists based in Northern California who own Salinas Valley Urology Associates and formerly owned Advance Radiation Oncology Center, will pay roughly $1 million to settle claims they violated the False Claims Act by submitting claims to Medicare for image guided radiation therapy (IGRT) that was referred and billed in violation of the physician self-referral law (the “Stark Law”) and the Anti-Kickback Statute. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Provider Fraud,

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