Archive

August 17, 2017

Pharmaceutical companies Mylan Inc. and Mylan Specialty L.P. agreed to pay $465 million to settle charges they violated the False Claims Act by purposely misclassifying EpiPen as a generic drug to avoid paying higher Medicaid rebates. Under the Medicaid Drug Rebate Program, state Medicaid programs are entitled to larger rebates for brand-name drugs compared to generics. According to the government, Mylan circumvented this program and its purpose by erroneously reporting EpiPen as a generic drug to Medicaid so it could demand massive price increases in the private market while avoiding its corresponding rebate obligations to Medicaid. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by competing pharmaceutical manufacturer Sanofi-Aventis US. Sanofi will receive a whistleblower award of roughly $38.7 million from the proceeds of the government’s recovery. Whistleblower Insider

Tagged in: Drug and DME Pricing, FCA Federal, Pharma Fraud, Whistleblower Case, Whistleblower Eligibility, Whistleblower Rewards,

August 11, 2017

Marie Neba, the owner and director of nursing of Houston home health agency Fiango Home Healthcare Inc., was sentenced today to 75 years in prison for her role in a $13 million Medicare fraud scheme involving the payment of illegal kickbacks to patient recruiters for referring Medicare beneficiaries to Fiango for home health services. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

August 3, 2017

The Medical Center of Central Georgia, Inc. (d/b/a The Medical Center, Navicent Health) agreed to pay roughly $2.6 million to resolve allegations it violated the False Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Navicent paramedic Andre Valentine. He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (MDGA)

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

November 22nd, 2017

California announced a $2 million settlement with Cottage Health System and its affiliated hospitals in California resolving allegations that they failed to implement basic, reasonable safeguards to protect patient medical information in violation of state and federal privacy laws. The settlement requires Cottage to maintain security practices and procedures to protect patients’ medical information from unauthorized access or disclosure. This settlement follows two separate data breach incidents by Cottage Health where more than 50,000 patients’ medical information was made publicly available online. CA

Tagged in: Cybersecurity and Data Breaches, Healthcare Fraud,

November 17th, 2017

New York announced the indictment of Hin T. Wong ("Wong"), 49, of Manhattan, Mery Gooden, 58, of the Bronx, and three pharmacies. The indictment charges Wong, the owner of three Manhattan pharmacies – New York Pharmacy Inc. ("NY Pharmacy"), NYC Pharmacy Inc. ("NYC Pharmacy"), and New York Healthfirst Pharmacy Inc. ("NY Healthfirst") – for defrauding several government-funded healthcare programs, including Medicaid and Medicare, by falsely billing prescription refills and stealing over $3 million in reimbursement for medication they did not dispense. Wong was indicted for Grand Larceny in the First Degree, a class "B" felony, and other crimes. In addition, Mery Gooden, a pharmacist at NYC Pharmacy, was indicted for Grand Larceny in the Second Degree and other related crimes. NY

Tagged in: FCA State, Medical Billing Fraud, Pharma Fraud,

November 16th, 2017

New York announced the arrests of unlicensed plastic surgeon Brad Jacobs, 56, of Westbury, NY, and licensed physician Nicholas Sewell, 74, of Jackson Heights, NY, on charges they engaged in a four-year scheme to illegally perform plastic surgeries on over 60 patients, including causing permanent disfigurement to one patient. Jacobs, a former plastic surgeon, surrendered his New York medical license in 2007 after the New York State Department of Health charged him with 29 specifications of Professional Medical Misconduct. From September 2012 to June 2016, Jacobs and Sewell allegedly defrauded patients undergoing costly cosmetic surgery procedures – each averaging between $8,000 and $10,000 – by falsely representing that Jacobs was authorized to practice medicine. NY

Tagged in: Healthcare Fraud, Improper Medical Personnel,

November 15th, 2017

New York announced the sentencings of Kenneth Cohn, Sharon Cohn, and Yellow Medi-Van and Taxi, Inc., for stealing hundreds of thousands of dollars in Medicaid funds and knowingly operating transportation services without Worker’s Compensation insurance. At sentencing in Broome County Court, the Cohns forfeited and released $455,604 currently being withheld by the New York State Department of Health, to the Attorney General’s Medicaid Fraud Control Unit. Each defendant also agreed to pay $50,000 in restitution, for a total of $100,000. Kenneth Cohn was sentenced to five years’ probation, and Sharon Cohn was sentenced to one year conditional discharge. Yellow Medi-Van and Taxi, Inc. was sentenced to three years conditional discharge. NY

Tagged in: Healthcare Fraud, Medicaid,

October 16, 2017

Louisiana announced the arrests of three New Orleans women as a result of an investigation exposing over $2 million in Medicaid Fraud. Lanice Stamps, 44 of New Orleans and owner of A New Direction Support Services, was arrested on 10 counts of Medicaid fraud for allegedly providing false and fraudulent claims for behavioral health services not rendered. Many recipients were fraudulently diagnosed as moderately mentally retarded or severely autistic so that the claims submitted could be billed at a higher level and they had never received counseling services. LA

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

September 7, 2017

The Hartford Dispensary will pay $627,000 through a federal-state settlement to resolve allegations that it violated the False Claims Act by falsely certifying to federal and state officials that it had a current medical director that was performing his duties in accordance with federal and state law. In 2014, the Office of the Attorney General commenced an investigation after a whistleblower complaint about the Hartford Dispensary, a private nonprofit behavioral health organization; the investigation was followed by a qui tam lawsuit alleging various violations of the state and federal False Claims Act. The state’s investigation focused on services that Hartford Dispensary provides as an opioid treatment program – primarily methadone and detoxification services.

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

September 5, 2017

Novo Nordisk, Inc. has agreed to $1.1 million to resolve claims that its diabetes drug Victoza was unlawfully promoted for off-label use in violation of the California Insurance Frauds Prevention Act. The claims were brought in a whistleblower action under that act filed by former Novo Nordisk researcher Peter Dastous, who will receive a share of the settlement. CA

Tagged in: Off-Label and Unapproved Use, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Whistleblower Case, Whistleblower Rewards,

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