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June 14, 2017

Mildrey Gonzalez and her daughter Milka Alfaro were sentenced to 135 and 151 months in prison, respectively, and to pay roughly $22.9 million in restitution for their roles in a $20 million Medicare fraud conspiracy that involved paying illegal health care kickbacks to patient recruiters and medical professionals. They previously admitted they secretly co-owned and operated seven home health agencies in the Miami area, yet failed to disclose their ownership interests in any of these agencies to Medicare, as required by relevant rules and regulations. They further admitted to paying illegal health care kickbacks to a network of patient recruiters in order to bring Medicare beneficiaries into the scheme, to paying bribes and kickbacks to medical professionals in return for providing home health referrals, and to directing co-conspirators to open shell corporations, into which millions of dollars’ worth of fraud proceeds were funneled. DOJ

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

June 13, 2017

New Jersey doctor Robert Claude McGrath and his chiropractor son Robert Christopher McGrath admitted to conspiring to defraud Medicare by using unqualified people to give physical therapy to Medicare recipients. Together with their practice, the Atlantic Spine & Joint Institute, they also agreed to pay $1.78 million to resolve allegations they violated the False Claims Act through the illegal billings. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Linda Stevens, a former billing manager at Atlantic Spine. She will receive a whistleblower award of roughly $338,200 from the proceeds of the government's recovery. DOJ (DNJ)

Tagged in: Chiropractic, Healthcare Fraud, Improper Medical Personnel, Medicare, Whistleblower Case, Whistleblower Rewards,

June 26, 2017

New York announced the arrest and indictment of registered nurse Collins Anyanwu-Mueller, 47, for allegedly submitting over $390,000 of false claims over the course of nearly five years for private-duty nursing services that he did not provide. Anyanwu-Mueller was arraigned today in Westchester County Court in White Plains before the Honorable Larry J. Schwartz on an indictment charging him with Grand Larceny in the Second Degree, a class C felony carrying a maximum sentence of up to 15 years in state prison, and Offering a False Instrument for Filing in the First Degree, a class E felony that carries a maximum sentence of up to four years in state prison. If convicted, Anyanwu-Mueller faces up to 15 years in state prison. NY

Tagged in: Healthcare Fraud,

June 7, 2017

Texas-based medical and physical therapy provider Union Treatment Center agreed to pay $3 million to settle charges it violated the False Claims Act by defrauding the federal workers’ compensation (FECA) program.  The company will also waive claims for payment exceeding $1.6 million and be permanently excluded from participating in federal health care programs.  According to the government, UTC fraudulently billed the FECA program for services it did not render, routinely overcharged for medical examinations, falsely inflated the time patients spent in therapy, billed for unnecessary services and supplies, and paid kickbacks in exchange for patient referrals.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (WDTX)

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

June 5, 2017

Texas-based Integrated Medical Solutions Inc. and the company’s former president Jerry Heftler agreed to pay roughly $2.5 million to settle allegations they violated the False Claims Act and Anti-Kickback Act in connection with the U.S. Bureau of Prisons. DOJ

Tagged in: Correctional Services Fraud, Medicare, Other Government Health Programs,

June 2, 2017

Fredericksburg Hospitalist Group, P.C. agreed to pay roughly $4.2 million to settle charges it violated the False Claims Act by upcoding evaluation and management (E&M) codes to the highest code levels in billing Medicare and other federal healthcare payors in connection with their providing hospitalist services to patients at Mary Washington Hospital and Stafford Hospital.  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 whistleblower award from the proceeds of the government's recovery. DOJ (EDVA)

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Upcoding,

May 31, 2017

Massachusetts-based eClinicalWorks, one of the country's largest vendors of electronic health records software, along with certain of its employees, agreed to pay $155 million to resolve charges the company violated the False Claims Act by misrepresenting the capabilities of its software.  The company also allegedly paid kickbacks to certain customers in exchange for promoting its product.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement.  He will receive a whistleblower award of roughly $30 million from the proceeds of the government's recovery. DOJ

Tagged in: Contract Non-Compliance, Electronic Health Records, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

May 31, 2017

New Jersey-based skilled nursing facility Andover Subacute and Rehab Center Services Two Inc. agreed to pay $888,000 to resolve charges it violated the False Claims Act by providing materially substandard or worthless nursing services to patients. DOJ (DNJ)

Tagged in: FCA Federal, Healthcare Fraud, SNF,

May 30, 2017

Florida-based managed care service provider Freedom Health Inc. agreed to pay roughly $32 million to settle charges it violated the False Claims Act by engaging in illegal schemes to maximize its Medicare Advantage plan payments from the government.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Freedom Health employee and Constantine Cannon client Darren D. Sewell.  He will receive a yet-to-be-determine whistleblower award from the proceeds of the government's recovery.  Whistleblower Insider

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Risk Adjustment Fraud, Whistleblower Case, Whistleblower Rewards,

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