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July 17, 2017

New York-based home health care company Visiting Nurse Service of New York and its subsidiaries VNS Choice and VNS Choice Community Care agreed to pay roughly $4.4 million to settle charges of violating the False Claims Act by improperly collecting monthly Medicaid payments for 365 Medicaid beneficiaries whom VNS Choice failed to timely disenroll from the VNS Choice Managed Long-Term Care Plan.  Once VNS disenrolled the members, it did not repay Medicaid for the funds it had improperly received. By knowingly retaining overpayments for many of these members for more than 60 days, the VNS entities violated both the federal and state false claim acts. As a result, New York State will receive $2.63 million as part of the settlement agreement.The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by an undisclosed whistleblower.  The whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)  NY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Whistleblower Case, Whistleblower Rewards,

July 13, 2017

New York announced the convictions of Kenneth Cohn and Sharon Cohn and Yellow Medi-Van and Taxi, Inc., for Medicaid fraud and related charges. Broome County residents Kenneth Cohn and Sharon Cohn owned and operated Yellow Medi-Van and Taxi, Inc., a transportation company providing transportation to medical appointments for Medicaid recipients in Broome County. During the period June 2, 2012, to January 30, 2014, the defendants knowingly operated Yellow Medi-Van and Taxi in violation of Broome County transportation regulations and the New York State Workers’ Compensation Act, by failing to have Worker’s Compensation insurance. The defendants agreed to forfeit and release $455,604.39 of the funds received from Medicaid to the New York State Medicaid Fraud Control Unit. They also entered into a settlement agreement for an additional $50,000.00. NY

Tagged in: Medicaid,

July 6, 2017

Cathy Morris and Josie King, former employees of Compassionate Care Hospice of Atlanta, will receive a yet-to-be-determined whistleblower award from the $24 million the company and its parent Compassionate Care Hospice Group, Inc. agreed to pay to resolve charges they violated the False Claims Act and Stark Law by engaging in improper financial relationships with contracted physicians to induce them to refer patients.  DOJ (NDGA)

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

July 6, 2017

Maureen Fox and Cathy Gonzales, former employees of now-defunct Home Care Hospice, Inc., will receive a yet-to-be-determined whistleblower award from the millions of dollars to be paid by the owners of the company to settle charges they falsely billed for hospice services that were either unnecessary or never provided.  DOJ (EDPA)

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

July 6, 2017

Whistleblowers will receive an award of more than $350,000 from the $2 million Pennsylvania hospice company Compassionate Care of Gwynedd Inc. agreed to pay to resolve allegations it violated the False Claims Act by providing unnecessary hospice services.  DOJ (DNJ)

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

June 28, 2017

Paul Chan will receive a whistleblower award of more than $9.2 million from the $42 million to be paid by PAMC Ltd. and Pacific Alliance Medical Center Inc. (which together own and operate Los Angeles acute care hospital Pacific Alliance Medical Center) to settle charges they violated the False Claims Act and the Stark Law by engaging in improper financial relationships with referring physicians.  DOJ

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

June 22, 2017

Dr. James M. Crumb, a physical medicine and rehabilitative specialist currently practicing in Alabama as Mobility Metabolism and Wellness, P.C.,and Coastal Neurological Institute, P.C., a local neurosurgeon physician group, agreed collectively to pay $1.4 million to resolve allegations they violated the False Claims Act by billing federal health care programs for medically unreasonable and unnecessary ultrasound guidance used with routine lab blood draws, and with Botox and trigger point injections. As a result of this billing scheme, the defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient office visit. DOJ (SDAL)

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding,

June 20, 2017

New Jersey family doctor Bernard Greenspan was sentenced to 41 months in prison and to pay a $125,000 fine and a roughly $200,000 forfeiture for violating the Anti-Kickback Statute by accepting bribes in exchange for test referrals as part of a long-running scheme operated by Biodiagnostic Laboratory Services LLC, its president and numerous associates. Greenspan’s referrals generated approximately $3 million in lab business for BLS. DOJ (DNJ)

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF,

June 16, 2017

Pennsylvania-based skilled nursing facility operator Genesis Healthcare Inc. agreed to pay roughly $53.6 million to settle charges that companies and facilities acquired by Genesis violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Joanne Cretney-Tsosie, Jennifer Deaton, Kimberley Green, Camaren Hampton, Teresa McAree, Terri West, and Brian Wilson, former employees of companies acquired by Genesis. They collectively will receive a whistleblower award of $9.67 million from the proceeds of the government's recovery. DOJ

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

June 15, 2017

Kentucky allergists Bruce Wolf and Kiro John Yun agreed to pay $740,578 to resolve allegations their medical practice group of otolaryngologists Wolf and Yun, P.S.C., specializing in allergy, asthma and immunology, violated the False Claims Act by billing the government for Sublingual Immunotherapy serum preparation and overstated units of serum preparation for injection vials. Sublingual immunotherapy is an alternative way to treat allergies without injections whereby an allergist prescribes a patient with an allergen that is sprayed under the tongue to boost tolerance to substances and reduce symptoms but it is not covered by Medicare because it is considered investigational. DOJ (WDKY)

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

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