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November 13, 2019

The Louisiana Department of Health, which manages Louisiana’s Medicaid program, will pay $13.42 million to the federal government to resolve allegations that the state submitted false claims for federal share reimbursement of state Medicaid expenditures for long-term nursing care and hospice care.  The federal government alleged that in anticipation of a reduction in federal payments for such services, the state agency directed its healthcare contractor, Molina Medical Solutions, to pre-bill for nursing home and hospice services in order to receive funds at the existing higher rates.   DOJ

November 8, 2019

Lenox Hill Hospital and its corporate parent, Northwell Health, Inc., have agreed to pay $12.3 million for violating the Stark Law and False Claims Act in submissions to Medicare.  From 2013 to 2018, Lenox Hill paid the chair of its urology department, Dr. David Samadi, a salary and bonus that improperly took into account the value of his referrals and grossly exceeded fair market value.  In an effort to maximize revenue-generating surgeries, Samadi was repeatedly scheduled to perform overlapping surgeries, leaving patients with unsupervised medical residents in violation of both hospital and Medicare rules.  The department also billed Medicare for minor procedures performed in operating rooms with an unnecessarily full operating room staff.  USAO SDNY

November 8, 2019

In the eleventh settlement involving the multi-state OK Compounding Pharmacy fraud scheme, podiatrist Jonathan Moore of Kentucky has agreed to pay $65,404 for the role he played in defrauding federal healthcare programs.  In exchange for illegal kickbacks disguised as “medical director fees,” Dr. Moore allegedly prescribed medically unnecessary compounded pain creams to patients, many of whom were insured by Medicare and TRICARE.  USAO NDOK

November 7, 2019

Compound drug ingredient supplier Fagron Holding USA LLC has agreed to pay over $22 million to resolve two qui tam suits involving three of Fagron’s wholly-owned subsidiaries.  According to whistleblowers, Freedom Pharmaceuticals Inc. grossly inflated the price of active pharmaceutical ingredients used in compound prescriptions, causing pharmacy customers to submit false claims to TRICARE.  Other allegations involved subsidiaries Pharmacy Services Inc. and B&B Pharmaceuticals Inc., which were accused of submitting false claims to federal healthcare programs, manipulating prescription drug pricing, paying kickbacks to physicians, and illegally waiving patient copays.  DOJ

November 5, 2019

A home health agency that allegedly defrauded Medicare and Louisiana’s Medicaid program has agreed to pay $2.5 million to settle claims arising from a qui tam suit.  Defendants Health Care Options, Inc., Health Care Options of Lafayette, Inc., Home Care Options Houston, Inc., and Howard Austin, II allegedly submitted reimbursement claims involving non-face-to-face encounters, as required by program rules.  USAO MDLA

November 1, 2019

A New York-based painting contractor has agreed to pay $3 million to settle a suit alleging it misrepresented compliance with Disadvantaged Business Enterprise (DBE) rules in connection with two federally funded construction projects.  The False Claims Act violations involved Ahern Painting Contractors Co., which was contractually required to hire DBE subcontractors to perform renovation work on the Brooklyn Bridge and Queens Plaza.  However, Ahern hired a non-DBE, Spectrum Painting Corp., and repeatedly submitted false statements to the government that represented the work was done by a real DBE, Tower Maintenance Corp.  USAO SDNY

October 29, 2019

Encompass Health Corporation (EHC), f/k/a HealthSouth Corporation, has agreed to pay $4 million to resolve of improperly billing Medicare.  According to the DOJ, between 2008 and 2012, an inpatient rehabilitation facility owned by EHC had improperly assigned low Functional Independence Measure scores on Patient Assessment Instrument forms in a bid to receive higher reimbursements from Medicare.  USAO NV

October 28, 2019

Sanford Health, Sanford Medical Center, and Sanford Clinic have agreed to pay $20.25 million and enter into a Corporate Integrity Agreement in order to resolve alleged violations of the Anti-Kickback Statute and False Claims Act.  Despite warnings by several physicians that a top neurosurgeon was illegally profiting off his use of implantable medical devices as well as performing medically unnecessary surgeries involving the devices, Sanford did nothing to stop the offender, allowing Medicare and Medicaid to continue being defrauded.  The allegations were raised by Sanford surgeons Drs. Carl Dustin Bechtold and Bryan Wellman, who will share in a $3.4 million cut of the settlement proceeds.  DOJ; USAO SD

October 25, 2019

Two foundations that provide pharmaceutical co-payment assistance to patients have reached agreements to resolve claims that they failed to operate independently of their pharmaceutical company donors and violated or caused the violation of the False Claims Act and Anti-Kickback Statute by working with those companies to ensure that donations received from them would be used to cover co-payments for the donor's drugs, inducing patients to purchase the drugs.  The Chronic Disease Fund, Inc. will pay $2 million, and the Patient Access Network Foundation will pay $4 million, amounts that were arrived at based on the entities' abilities to pay.  CDF was alleged to have conspired with Novartis, Dendreon, Astellas, Onyx, and Questcor.  PANF was alleged to have conspired with Bayer, Astellas, Dendreon, and Amgen.  The foundations also entered into 3-year corporate integrity agreements.  USAO MA

October 18, 2019

Following a government analysis of Medicare claims data and a whistleblower's qui tam lawsuit, seven former Osteo Relief Institutes and their owners have agreed to pay more than $7.1 million to settle claims of defrauding Medicare.  The alleged fraud involved clinics in Arizona, California, Kentucky, New Jersey, and Texas billing Medicare for medically unnecessary treatments for osteoarthritis, including viscosupplementation injections and knee braces.  The whistleblower involved will receive $857,550.  DOJ
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