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July 13, 2017

New York podiatrist Perrin D. Edwards pled guilty to health care fraud for illegally charging Medicare and private insurance companies for podiatry services he never provided and agreed to pay $410,000 to resolve charges of violating the False Claims Act.  DOJ (NDNY)

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

July 11, 2017

Mallinckrodt LLC, a pharmaceutical manufacturer and one of the largest manufacturers of generic oxycodone, agreed to pay $35 million to settle allegations it violated certain provisions of the Controlled Substances Act.  According to DOJ, it is the first settlement of its magnitude with a manufacturer of pharmaceuticals resolving nationwide claims the company did not meet its obligations to detect and notify DEA of suspicious orders of controlled substances such as oxycodone.  DOJ

Tagged in: Pharma Fraud,

July 7, 2017

Wal-Mart Stores Inc. agreed to pay $1.65 million to resolve allegations it violated the False Claims Act by submitting pharmacy claims to California’s Medi‑Cal program not supported by applicable diagnosis and documentation requirements.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a Wal-Mart pharmacist.  The whistleblower will receive a whistleblower award of roughly $264,000 from the proceeds of the government's recovery.  DOJ (EDCA)

Tagged in: Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

July 6, 2017

New Jersey-based Compassionate Care Hospice Group, Inc. agreed to pay $2.4 million to resolve charges that the company and its subsidiary Compassionate Care Hospice of Atlanta violated the False Claims Act and Stark Law by engaging in improper financial relationships with contracted physicians to induce them to refer patients.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former CCH Atlanta employees Cathy Morris and Josie King.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (NDGA)

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Whistleblower Case,

July 6, 2017

Matthew Kolodesh, Alex Pugman, Svetlana Ganetsky, and Malvina Yakobashvili agreed to pay millions of dollars to settle False Claims Act allegations that they and their now-defunct company Home Care Hospice, Inc. falsely billed for hospice services that were either unnecessary or never provided.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former HCH employees Maureen Fox and Cathy Gonzales.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (EDPA)

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

July 6, 2017

Pennsylvania hospice company Compassionate Care of Gwynedd Inc., and a subsidiary of New Jersey-based Compassionate Care Hospice Group Inc., agreed to pay $2 million to resolve allegations it violated the False Claims Act by providing unnecessary hospice services.  The government alleged the company admitted patients by using a diagnosis of “debility” that was not medically justified.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive an award of more than $350,000 from the proceeds of the government's recovery.  DOJ (DNJ)

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medicare, Whistleblower Case,

July 5, 2017

Reliant Care Group, Reliant Care Management Company, Reliant Care Rehabilitative Services, and a number of Reliant affiliated skilled nursing facilities agreed to pay roughly $8.4 million to settle charges they violated the False Claims Act by billing Medicare for unnecessary physical, speech, and occupational therapy to nursing home residents.  DOJ (EDMO)

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF,

June 30, 2017

Dawn Bentley, a Detroit-area medical biller, was sentenced to 50 months in prison and to pay roughly $3.3 million for her role in a $7.3 million Medicare and Medicaid fraud scheme involving medical services that were billed to Medicare and Medicaid but not rendered as billed.  DOJ

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

June 30, 2017

Charlotte-Mecklenburg Hospital Authority (dba Carolinas Healthcare System) agreed to pay $6.5 million to resolve charges it violated the False Claims Act by “upcoding” claims for urine drug tests in order to receive higher payment than allowed for the tests.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Mark McGuire, a former laboratory director for CHS.  He will receive a whistleblower award of roughly $1.4 million from the proceeds of the government's recovery.  DOJ (WDNC)

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 29, 2017

Innovative Therapies, Inc. and its parent company Cardinal Health, Inc. agreed to pay roughly $2.7 million to settle charges they violated the False Claims Act by submitting false claims to Medicare through their marketing of certain negative pressure wound treatment devices as durable medical equipment when they knew these devices did not have the expected life of a durable device.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former ITI employee.  The whistleblower will receive an award of $488,700 from the proceeds of the government's recovery.  DOJ (MDTN)

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

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