Contact

Click here for a confidential contact or call:

1-212-350-2764

Archive

Page 1 of 121

September 3, 2020

Having previously pleaded guilty to healthcare fraud and related charges, Arizona urgent care provider UCXtra Umbrella, LLC, which did business as "Urgent Care Extra," was sentenced to pay restitution of $12.5 million.  Defendant admitted that it ordered tests and procedures that were not medically necessary and that its billings intentionally overstated the complexity of services to patients in order to receive inflated reimbursements from private insurance companies. USAO AZ

September 3, 2020

Two affiliates of Independence Blue Cross, Keystone Health Plan East, Inc. and QCC Insurance Company, Inc., which offer Part C Medicare Advantage plans, agreed to pay $2.25 million to resolve allegations that they overstated their costs when they submitted bids to CMS for contract years 2009 and 2010.  As a result, CMS reimbursed them at at an inflated rate.  The matter was initiated by the filing a qui tam complaint under the False Claims act by Eric Johnson, who will receive $500,000 from the recovery.  USAO EDPA

August 24, 2020

Following a whistleblower suit by a former sales representative, DUSA Pharmaceuticals (DUSA), a Massachusetts-based subsidiary of Sun Pharmaceuticals Industries Inc. (Sun Pharma), has agreed to pay $20.75 million to resolve allegations of defrauding Medicare and the Federal Employee Health Benefit Pr­­­ogram.  According to relator Aaron Chung, senior management at DUSA and Sun Pharma allegedly encouraged doctors, via paid speaker programs and discussions, to use shorter incubation periods of 1-3 hours for Levulan Kerastick, a topical prescription medication for treating actinic keratosis (AK) of the face and scalp that had FDA-approved instructions for 14-18 hour incubation periods.  As expected, the significantly reduced incubation periods resulted in significantly reduced AK clearance rates, yet DUSA failed to inform doctors of the lower rates and even actively misinformed them that AK clearance rates were the same regardless of incubation period.  For exposing the fraudulent conduct, Chung will receive approximately $3.5 million of the settlement proceeds.  DOJ; USAO WDWA

August 21, 2020

A Georgia-based chiropractor and her medical practice have been ordered to pay more than $5 million for violating the False Claims Act.  The government alleged that Dr. Jennifer Heller, D.C. caused Medicare to pay $1.4 million more than it would have had it known that hundreds of Heller’s charges for a surgical neurostimulator procedure were in actuality for acupuncture devices, which are not covered by Medicare, and which do not require surgery.  To resolve the charges, Heller Family Medicine, LLC will have to pay $4.3 million, while Heller herself will have to pay $700,000.  USAO SDGA

August 13, 2020

Advanced Care Scripts, Inc. (ACS) has agreed to pay $3.5 million to resolve allegations of conspiring with Teva Neuroscience, Inc. (Teva) to pay kickbacks to Medicare beneficiaries in order to induce purchases of Teva’s multiple sclerosis drug, Copaxone.  The kickbacks came in the form of effectively covering beneficiaries’ co-pays through correlated payments to the Chronic Disease Foundation (CDF) and The Assistance Fund (TAF).  USAO MA

August 11, 2020

The former owner of Texas-based All Smiles Dental Center has been ordered to pay $16.5 million to the State of Texas for improperly billing Texas Medicaid for tens of millions of dollars in services that he did not deliver, including services allegedly performed while he was vacationing abroad.  In total, Dr. Richard Malouf was found to have committed 1,842 unlawful acts under the Texas Medicaid Fraud Prevention Act.  AG TX

July 30, 2020

Computer Sciences Corporation (CSC), now known as DXC Technology, and New York City have agreed to pay approximately $2.8 million to resolve allegations of violating the federal and New York State False Claims Acts in connection with New York City’s Early Intervention Program (EIP), which provides speech and physical therapy services for infants and toddlers with possible developmental disabilities.  According to a qui tam lawsuit, while retained by the City to process and submit its EIP claims to various insurers, CSC allegedly received permission from the City to categorize claims submitted to private insurers as “denied” if no response was received within 90 days.  CSC then resubmitted those claims to Medicaid using an improper code, causing Medicaid to make payments it would not have otherwise.  For revealing the misconduct, the unnamed whistleblower in this case will receive $416,250.  AG NY; USAO SDNY

July 28, 2020

A pharmaceutical company accused of paying illegal inducements to physicians has agreed to pay $3.5 million to resolve allegations of violating the False Claims Act.  In order to induce physicians to prescribe its newly-launched local analgesic, EXPAREL, Pacira Pharmaceuticals Inc. allegedly paid doctors kickbacks that were half-heartedly disguised as grant money for research.  In order to receive the so-called research grant, Pacira required EXPAREL to be placed on formulary at the physician’s institution, but did not document why such research was needed or follow up on research results.  The fraud was eventually exposed by a pharmacist in a qui tam suit; the pharmacist will receive $638,000 as part of the settlement.  USAO NJ; AG FL

July 24, 2020

Several divisions of pharmaceutical company Indivior, which marketed of the opioid-addiction drug Suboxone, pleaded guilty to felony healthcare fraud, entered into a five-year Corporate Integrity Agreement, and will pay a total of $600 million in criminal fines, restitution, civil damages, and penalties.  In six separate cases brought by whistleblowers, Indivior was also alleged to have caused false claims to be submitted to government healthcare programs including by promoting the sale of Suboxone to physicians who were prescribing it outside of medically accepted indication, misrepresenting the likelihood of Suboxone being diverted, and taking steps to delay generic competition for Suboxone. Indivior admitted making false statements about the safety of the film version of Suboxone in order to promote its sale.  In addition, the FTC claimed that violated antitrust laws through a deceptive scheme to thwart lower priced generic competition with Suboxone.  The total settlement consists of criminal restitution of $289 million; a civil settlement of $300 million, with $209.3 million paid to resolve claims by the federal government and $90.7 million to participating states; and, $10 million in penalties to the Federal Trade Commission.  The settlement also requires Indivior to take steps including the dissolution of its Suboxone sales force. Indivior was until 2014 a subsidiary of Reckitt Benckiser Group PLC, which previously paid $1.4 billion to resolve claims related to Suboxone marketing.  DOJ; USAO NJ; FTC

July 23, 2020

Two pharmacists who were co-owners of Advantage Pharmacy in Mississippi have been sentenced to over 12 years in prison each and ordered to pay between $9 million and $29 million in civil monetary judgment, and between $185 million and $189 million in restitution for committing healthcare fraud.  According to the press release, Glenn Doyle Beach and Hope Thomley marketed, dispensed, and distributed compounded medications without regard to medical necessity, causing various health benefit programs, including TRICARE, to pay over $200 million in reimbursements.  Thomley’s husband, Randy Thomley, has been sentenced to 8 years in prison and ordered to pay judgment and restitution of $3.6 million each for his role in helping to recruit TRICARE beneficiaries.  USAO SDMS
1 2 3 4 121

Newsletter

Subscribe to receive email updates from the Constantine Cannon blogs

Sign up for: