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December 14, 2017

Texas-based DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with severe kidney disease, agreed to pay $63.7 million to resolve charges of violating the False Claims Act by billing Medicare for prescription medications never shipped, shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent. The settlement also resolves allegations that DaVita paid financial inducements to Medicare beneficiaries in violation of the Anti-Kickback Statute. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by two former DaVita employees Patsy Gallian and Monique Jones. The whistleblowers will receive an award of $2.1 million from the proceeds of the government's recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 14, 2017

Mississippi-based Region 8 Mental Health Services agreed to pay roughly $7 million resolve charges of violating the False Claims Act allegations by submitting claims for services not provided or not provided by qualified individuals as part of its preschool Day Treatment program. It is believed to be the largest False Claims Act healthcare settlement in the history of the State of Mississippi. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Region 8 employee. The whistleblower will receive an award of more than $1 million from the proceeds of the government's settlement. DOJ (SDMS)

Tagged in: FCA Federal, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 12, 2017

Florida-based 21st Century Oncology Inc. agreed to pay $26 million to settle charges of violating the False Claims Act and the Stark Law through the company’s false attestation to the use of electronic health records software and through referrals from physicians with whom the company had improper financial relationships. DOJ

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

December 12, 2017

Mobile imaging companies PDQ Imaging Services, LLC, PDQ Ultrasound Services, LLC, PDQ Mobile X-Ray Services, PDQ Mobile X-Ray, LLC, along with their owners Dennis Whitsell and Jonathan Graham Lane, agreed to pay $300,000 to settle charges of violating the False Claims Act and Anti-Kickback Statute by improperly billing Medicare for transportation charges related to portable x-ray services and paying kickbacks to skilled nursing facilities in exchange for patient referrals. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Kevin P. McDonough and Boyd K. Billington. They will receive a whistleblower award of roughly $60,000 from the proceeds of the government's recovery. DOJ (EDTX)

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

December 12, 2017

Med-Fast Pharmacy, Inc. agreed to pay roughly $2.7 million to resolve both criminal and civil charges of violating the False Claims Act relating to the conduct of Iserve Technologies, Inc., a company co-located with and operated out of Med-Fast, filling prescriptions for nursing homes with recycled unused drugs that were commingled with drug stocks on hand at Med-Fast’s Institutional Pharmacy. The settlement also resolves allegations that Med-Fast sought Medicare and Medicaid reimbursement for the retail-packaged version of diabetes testing strips while actually supplying patients with cheaper mail-order-packaged version of the same strips. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ (WDPA)

Tagged in: Healthcare Fraud, Medical Billing Fraud, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 11, 2017

Yunesky Fornaris, the owner and operator of defunct Miami home health agency Elite Home Care, was sentenced to 115 months in prison and to pay $15.1 million in restitution for his role in a $15 million conspiracy to defraud the Medicare program through the enlisting of patient recruiters to recruit patients to Elite in exchange for illegal bribes and kickbacks. DOJ

Tagged in: Anti-Kickback and Stark, Home Health and Hospice,

December 20th, 2017

California announced a $13.5 million multistate settlement with pharmaceutical company Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI) for its deceptive and misleading representation and off-label marketing of its prescription drugs. California will receive $857,000. The settlement resolves allegations that BIPI misled the public about the uses and efficacy of prescription drugs, including Micardis, Aggrenox, Atrovent, and Combivent. The settlement comes after a multistate investigation found that BIPI engaged in deceptive practices. BIPI represented that its prescription drugs had sponsorship, approval, characteristics, ingredients, uses and benefits that they did not have. For example, BIPI engaged in off-label marketing and promoted its drugs to treat life-threatening conditions, such as heart attacks, congestive heart failure, and strokes, without evidence to substantiate their claims. CA

Tagged in: Healthcare Fraud, Off-Label and Unapproved Use, Pharma Fraud,

December 13th, 2017

Illinois announced a $12 million settlement with a company that manufactures a device used primarily in spinal surgeries. The settlement with Medtronic Sofamor Danek, Inc. and Medtronic Sofamor Danek USA, Inc. (Medtronic) resolves allegations that the company misled consumers about the safety of its Infuse® Bone Graft Device. According to Madigan’s complaint, Medtronic used deceptive company-sponsored scientific literature to make false and misleading claims about Infuse’s safety, effectiveness and quality. The false marketing created an artificial demand for Infuse in a range of fusion surgeries. The company’s fraudulent conduct was the subject of a 16-month investigation by the U.S. Senate Finance Committee. IL

Tagged in: Defective Products, Healthcare Fraud,

December 1, 2017

Pine Creek Medical Center LLC, a physician-owned hospital serving the Dallas/Fort Worth area, agreed to pay $7.5 million to resolve claims it violated the False Claims Act and Anti-Kickback Statute by paying physicians kickbacks in the form of marketing services in exchange for surgical referrals.  Specifically, Pine Creek allegedly paid for advertisements on behalf of the physicians as well as radio and television advertising, pay-per-click advertising campaigns, billboards, website upgrades, brochures, and business cards, and other forms of marketing to induce physicians to refer patients to Pine Creek for medical services.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former Pine Creek employees Suzanne Scott and Savannah Sogar.  They will receive a whistleblower award of $1,125,000 from the proceeds of the government's recovery.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

December 1, 2017

Skin Care Doctors, P.A. and its founder and CEO Michael J. Ebertz, M.D., agreed to pay $850,000 to resolve allegations of violating the False Claims Act by submitting false claims to Medicare in connection with certain dermatology products and procedures.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a doctor who formerly worked with Ebertz.  The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery.  DOJ (DMN)

Tagged in: FCA Federal, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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