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February 28, 2024

The owner and operator of a clinical laboratory in Georgia has pleaded guilty and agreed to pay $14.3 million to resolve charges of paying illegal kickbacks and causing false claims to be submitted to Georgia’s Medicaid program.  According to Capstone Diagnostics’ former laboratory manager, Andrew Maloney directed Capstone to pay volume-based commissions to independent sales representatives in exchange for them arranging medically unnecessary urine drug tests and respiratory pathogen panels to come their way.  The laboratory ultimately submitted over $1 million in tainted claims to Georgia Medicaid.  For bringing a successful case under the False Claims Act, whistleblower Jesse Allen will receive almost $3 million.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Whistleblower Case, Whistleblower Rewards,

February 1, 2024

One of the nation’s largest healthcare systems, Providence, has agreed to forgive more than $137 million in medical debt and refund more than $20 million to patients following a lawsuit by Washington State.  According to the Attorney General’s Office, between 2018 and 2023, Providence trained staff to demand payments from low income patients who were eligible for financial assistance, then sent some of those same patients to debt collectors even if they were Medicaid beneficiaries.  Almost 99,500 patients will receive relief as a result of this settlement, with the average refund amounting to about $478.  WA AG

Tagged in: Healthcare Fraud, Provider Fraud,

February 1, 2024

Marketing firm Publicis Health, which was agency of record for all of Purdue Pharma’s branded opioid drugs as well as for other opioid manufacturers, has agreed to a $350 million national settlement for helping to fuel the prescription opioid crisis.  A government investigation found that the multinational company farmed data from recordings of conversations between patients and providers and used that data to develop Purdue’s sales tactics.  As part of this settlement, Publicis has also agreed to disclose thousands of internal documents detailing its work for opioid companies, such as Purdue, on a public website.  CA AG; NC AG; PA AG

Tagged in: Healthcare Fraud,

February 1, 2024

Hikma Pharmaceauticals has reached a settlement in principle with multiple states for $150 million following allegations that the opioid manufacturer failed to monitor and report suspicious orders.  From the settlement proceeds, $115 million will be paid in cash, while the remaining $35 million will be allocated toward opioid addiction treatment medications.  CA AG; NC AG; VA AG

Tagged in: Healthcare Fraud, Pharma Fraud,

January 31, 2024

In the fourth-largest Controlled Substances Act (CSA) settlement in history, e-commerce company eBay has agreed to pay $59 million for its failure to properly regulate the sales of pill presses and encapsulating machines on its website.  Such devices can be used to produce pills that mimic pills produced by legitimate pharmaceutical companies.  To combat this, the CSA requires that purchasers of such devices have their identities verified, recorded, and reported to the DEA; however, eBay failed to do so.  DOJ

Tagged in: Healthcare Fraud, Medical Devices and DME,

January 24, 2024

Johnson & Johnson has agreed to pay $149.5 million to Washington State for its role in fueling the opioid epidemic after the Attorney General Bob Ferguson rejected a 2021 settlement and chose to continue litigation.  The company was a top supplier of ingredients used to make opioid drugs, and marketed the drugs for chronic pain conditions that studies showed were not effectively treated by opioids.  This is the fifth national settlement that Washington State has rejected, and the third so far that has netted the state more than it would have received under the national settlement.  WA AG

Tagged in: Healthcare Fraud,

January 16, 2024

Silver Lake Hospital, a long-term care hospital in New Jersey, will pay $18.6 million, and its principal investors Dr. Richard Lipsky and Columbus Management South LLC will pay another $12 million, to resolve allegations of violating the False Claims Act and Federal Debt Collection Procedures Act (FDCPA).  The hospital allegedly claimed excessive cost outlier payments from Medicare, well in excess of its needs or ability to repay, and transferred millions of dollars to investors without receiving equivalent value in return.  DOJ

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

January 10, 2024

Clinical laboratory RDx Bioscience Inc. and its owner and CEO Eric Leykin have agreed to pay over $10 million to the federal government and about $3 million to the State of New Jersey for violating the Anti-Kickback Statute and federal and state False Claims Acts.  From 2018 to 2022, RDx and Leykin were allegedly involved with five types of kickback schemes in order to induce referrals to RDx for laboratory testing, then submitted or caused false claims to be submitted to Medicare and Medicaid that were unnecessary or uncovered.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare,

January 5, 2024

A Florida man, Karel Felipe, and Florida woman, Tamara Quicutis, have been sentenced to 8 years and 5 years respectively for their roles in a $93 million fraud scheme against Medicare.  Felipe and Quicutis were found guilty last October of submitting claims on behalf of three Michigan-based home health companies, for services never rendered, using stolen patient information, and then laundering the proceeds through dozens of shell companies and hundreds of bank accounts.  Their fellow co-conspirators—Jesus Trujillo, Didier Arcia, Alexey Gil, and Jeffrey Avila—have already been sentenced for their roles.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, Money Laundering,

January 4, 2024

ChristianaCare has paid $42.5 million for violations of the federal False Claims Act and the Delaware False Claims and Reporting Act. In a qui tam whistleblower complaint filed in 2017, ChristianaCare's former chief compliance officer alleged illegal remuneration was provided to non-employee neonatologists and surgeons in the form of free or below fair market services by ancillary support providers, such as nurse practitioners, hospitalists, and physician assistants. These services were meant to induce referrals from the non-employees, creating a financial relationship. USAO DE

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

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