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June 8, 2023

Steven King, chief compliance officer of A1C Holdings LLC, a pharmacy holding company, was convicted for violating Medicare and pharmacy benefit manager rules by securing prescriptions and refills for medically unnecessary lidocaine and diabetic testing supplies. King and his co-conspirators fraudulently billed Medicare over $50 million, taking steps to conceal their scheme by enrolling their mail order pharmacies as brick-and-mortar retail locations, shipping prescription refills for high-reimbursing medications and supplies without patient consent, concealing the ownership of A1C Holdings LLC and its pharmacies, and transferring patients among pharmacies without patient consent. King faces a maximum penalty of 20 years in prison for committing health care fraud and wire fraud. DOJ

Tagged in: Healthcare Fraud, Improper Medical Facility, Lack of Medical Necessity, Medicare, Pharma Fraud,

May 31, 2023

VHS of Michigan Inc., d/b/a, The Detroit Medical Center, Vanguard Health Systems Inc., and Tenet Healthcare Corporation will pay nearly $30 million for causing the submission of false or fraudulent claims to Medicare. From January 1, 2014 through December 31, 2017, DMC, Vanguard, and Tenet violated the Anti-Kickback Statute when they provided the services of mid-level practitioners to 13 physicians at no cost or below fair market value. The physicians were selected for their high number of referrals, which DMC hoped would cause an increase in referrals to their facilities. Whistleblower Dr. Jay Meythaler will receive $5.2 million as part of the settlement. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicare, Provider Fraud, Whistleblower Case,

April 28, 2023

Joyce Agu, of Sugar Land, TX, will spend 60 months in prison and will pay over $3 million in restitution for conspiring to pay and receive kickbacks for services billed to Medicare. Agu paid others to certify that her clients were eligible for home health services, which they were not, but she used the certifications anyway as a basis to submit false claims to Medicare. TX AG

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

April 20, 2023

Matthew Taylor Witkowski will spend 60 months in prison for generating and purchasing fraudulent written orders for DME, and then, using his Dominican Republic-based business, marketed and sold those orders to pharmacies and DME suppliers. Witkowski’s fraud resulted in more than $8 million in false claims reimbursements being made by Medicare. Witkowski will forfeit over $4 million and pay restitution of over $8 million to Medicare. SDNY

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare, Provider Fraud,

April 20, 2023

Dr. Paul S. Koch, Koch Eye Associates, and Claris Vision violated the False Claims Act by paying kickbacks to optometrists who referred their patients to Koch and his companies for laser-assisted cataract surgery. Over a five-year period, from 2013 to 2017, Koch and his practices submitted false claims to Medicare based on those kickbacks. Koch will pay nearly $1.2 million to resolve the qui tam whistleblowers’ claims, and the two whistleblowers will receive $256,534.84 from the settlement. USAO RI

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 20, 2023

Miami doctors Lawrence Alexander and Dean Zusmer were sentenced to 33 months and 96 months in prison, respectively, for their scheme to defraud Medicare of $31 million. Zusmer, a chiropractor and DME company owner, paid kickbacks to acquire patient referrals and signed doctors’ orders, using overseas call centers to solicit unnecessary prescriptions from patients and telemedicine companies. Alexander, an orthopedic surgeon and co-owner of another DME company, concealed his participation by putting the DME company in the name of one of his family members. The companies received over $15 million from Medicare through their fraud. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare, Provider Fraud,

April 17, 2023

Sibley Hospital and parent company Johns Hopkins Health System will pay $5 million to resolve allegations of Stark Law violations. Over a four-year period, from 2008 to 2011, Sibley billed Medicare for ten cardiologists’ services to whom they were already paying compensation above fair market value. The Stark Law prohibits such an arrangement, to ensure that medical decision-making is not influenced by improper financial incentives but instead is based on the patient’s best interests. Sibley and Johns Hopkins self-disclosed the impropriety. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare,

April 14, 2023

Nine defendants will spend a combined 70 years in prison for their respective roles in a $126 million compounding fraud scheme. The co-conspirators defrauded the Department of Labor’s Office of Workers’ Compensation Programs and TRICARE by submitting false claims and paying kickbacks to patient recruiters and physicians for prescribing certain medications, based not on medical necessity but instead on the drugs’ hefty reimbursement rates. The patients received the compounded medications via mail, despite never requesting, wanting, or needing them. DOJ

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Pharma Fraud, Provider Fraud,

April 4, 2023

From 2014 to 2022, medical testing company Genotox Laboratories Ltd. paid kickbacks to their “1099” representatives, calculated as a percentage of the revenue Genotox received from Medicare, the Railroad Retirement Board, and TRICARE billings for testing orders facilitated or arranged for by these representatives. In addition to the kickbacks, Genotox also allowed providers to create “custom profiles” to pre-select the tests to order for their patients, often resulting in medically unnecessary testing, such as definitive drug testing for 22 or more drug classes. Genotox will pay $5.9 million, and Genotox’s former billing manager—the whistleblower in this qui tam action—will receive approximately $1 million. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 30, 2023

Pharmacist Gisele Nguyen will pay over $3.9 million for fraudulently billing Medicare for medications that were never dispensed. For at least a 5-year period, from 2014 to 2018, Nguyen, dba Natico Pharmacy, submitted fraudulent claims for prescriptions that were never dispensed, and inventory records reflected that the pharmacy did not purchase enough of the medications from wholesalers to meet the fraudulent demand. DOJ

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

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