Archive

January 4, 2018

Kim Ricard was sentenced to 51 months in prison and to pay roughly $2 million in restitution for her involvement in a $2 million home health kickback scheme carried out through a New Orleans area home health agency. DOJ

December 29, 2017

Maryland physician Nwaehihie H. Onyeaghala of Krystal Medical Associates, LLC agreed to pay $1 million to settle allegations he violated the False Claims Act by submitting false claims to Medicare for medically unnecessary autonomic nervous function tests and peripheral vascular tests.  According to the government, the tests were not medically necessary because Dr. Onyeaghala lacked the necessary equipment to conduct the tests, the patients did not have an autonomic nervous function disorder before the test was conducted, Dr. Onyeaghala lacked the specific training to conduct such tests and he only used the tests to monitor patient symptoms, not make any clinical decisions about future patient care.  DOJ (DMD)

December 28, 2017

Maryland physician Jui Chih Hsu agreed to pay roughly $1.2 million to settle claims of violating the False Claim Act by submitting false claims to Medicare for medically unnecessary vitamin injections and evaluation and management services that were not documented.  DOJ (DMD)

January 4, 2018

Kmart Corporation agreed to a $1 million settlement with the California Department of Insurance to resolve a whistleblower claim brought under the California Insurance Fraud Prevention Act.  KMart contracted with insurance companies to be reimbursed at a rate based on the company's charges to cash-paying customers, but was alleged to have submitted claims to private insurers in amounts that exceeded the agreed-upon rates.  CA

December 22, 2017

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation, agreed to pay $32.3 million to settle allegations that Kmart violated the False Claims Act through Kmart pharmacies offering discounted generic drug prices to cash-paying customers through various club programs without disclosing those prices when reporting to federal health programs its usual and customary prices. Usual and customary pricing is typically used by Medicare and the other federal health programs to establish reimbursement rates. The settlement is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by James Garbe. He will receive a whistleblower award of $9.3 million. DOJ

December 21, 2017

Rhode Island-based Dominion Diagnostics, Inc. agreed to pay $815,000 to resolve claims of violating the False Claims Act by presenting claims to Medicare and Vermont Medicaid for urine specimen validity testing when referring physicians did not specifically order the testing. DOJ (DVT)

December 21, 2017

Florida-based Haven Hospice agreed to pay roughly $5 million to resolve allegations that Haven violated the False Claims Act by knowingly billing the government for medically unnecessary and undocumented hospice services. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Haven employee Dr. John Simons. Dr. Simons will receive a whistleblower award of roughly $900,000 from the proceeds of the government's recovery. DOJ (MDFL)

December 20, 2017

Maryland-based pharmaceutical company United Therapeutics Corporation agreed to pay $210 million to resolve claims it violated the False Claims Act and Anti-Kickback Statute by using a foundation as a conduit to pay the copays of Medicare patients taking the company's pulmonary arterial hypertension drugs. The government charged that covering the copays was prohibited remuneration used to induce Medicare patients to purchase the company’s products. DOJ

December 19, 2017

Two physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million to settle charges of violating the False Claims Act and Anti-Kickback Statute for allegedly receiving kickbacks in exchange for patient referrals to hospitals owned by the now-defunct Health Management Associates. Dallas-based EmCare agreed to pay $29.6 million to resolve allegations it received remuneration from HMA to recommend patients be admitted to HMA hospitals on an inpatient basis when the patients should have been treated on an outpatient basis. In a separate settlement, Pennsylvania-based Physician's Alliance agreed to pay $4 million for allegedly accepting illegal remuneration from HMA to refer patients to two HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center. The allegations originated in whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Drs. Thomas Mason and Stephen Folstad brought the qui tam suit against EmCare and will receive a whistleblower award of roughly $6.2 million from the proceeds of the government's recovery. Former HMA hospital executives George E. Miller and Michael J. Metts brought the qui tam suit against Physician's Alliance and will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ

December 18, 2017

Florida-based pharmacy Glades Drugs, Inc. agreed to pay $300,000 to settle allegations of violating the False Claims Act by waiving or failing to collect required copayments from Medicare and TRICARE beneficiaries. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Glades pharmacy technician Elvens Vertus. Vertus will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (SDFL)