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August 27, 2021

John Peter Smith Hospital (JPS) in Texas has agreed to pay more than $3.3 million to resolve a qui tam suit filed by its former Director of Compliance, Erma Lee, which alleged that the hospital routinely applied billing modifiers that essentially double-billed federal healthcare programs for certain aspects of patients’ care.  Even after raising the issue internally, JPS allegedly failed to reimburse payors, prompting Lee to file the case in 2018.  For doing so, Lee will receive over $900,000 of the settlement proceeds.  USAO NDTX

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 26, 2021

Mental health and addiction services provider Connections Community Support Programs, Inc. has consented to the entry of judgment ordering payment of $15.3 million to resolve claims that it billed federal healthcare programs for mental health services performed by individuals without required professional qualification, billed using incorrect procedure codes, and failed to keep proper records regarding controlled substances.  Connections has filed for bankruptcy, and the government recovery will be limited by the availability of funds in the bankruptcy estate.  The settlement resolves claims brought in a qui tam lawsuit by two former Connections employees.  USAO Del

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

August 26, 2021

SuperCare Health, Inc., which provides home respiratory services and DME, will pay $3.3 million to resolve claims that the company submitted false claims for non-invasive ventilators in cases where those patients were no longer using the NIVs.  The case was initiated by the filing a whistleblower complaint by a former SuperCare respiratory therapist, Benjamin Martinez.  Mr. Martinez will receive a $612,000 whistleblower reward from the federal government.  USAO CD Cal

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

August 26, 2021

In-home care provider At Home Care LLC and its principal, Kevin Cox, will pay a total of $2.9 million to resolve allegations that they overcharged the Oregon Medicaid program, including by altering caregiver scheduling records and falsely billing for hours of in-home care that were not actually provided.  The company pleaded guilty to healthcare fraud charges, and agreed to be excluded from government healthcare programs.  USAO Or

Tagged in: Criminal Proceedings, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

August 25, 2021

A California-based provider of home respiratory services and durable medical equipment has agreed to pay $3.3 million to the United States and States of California and Nevada to settle allegations of defrauding Medicare and Medicaid.  The claims against SuperCare Health, Inc. were brought in a 2018 qui tam suit by respiratory therapist Benjamin Martinez, who alleged that the provider billed for non-invasive ventilators (NIVs) that were no longer needed or being used by patients.  CA AG; USAO CDCA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 25, 2021

Georgia-based psychotherapy provide Carenow Services, LLC, together with its CEO Leena Karun, will pay $2 million to resolve allegations of FCA violations through their billing for services at nursing homes that were not medically necessary, that were improperly documented, and at higher intensity levels than justified.  The investigation was initiated when a former Carenow employee filed a qui tam complaint; the whistleblower will receive an undisclosed whistleblower reward.  USAO ND Ga

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, SNF, Upcoding, Whistleblower Case,

August 19, 2021

Nevada Advanced Pain Specialists agreed to pay $1 million to resolve allegations that it submitted false claims for confirmatory urine drug testing performed without regard to the results of presumptive tests that had been performed. The allegations were first brought in a qui tam lawsuit filed by an whistleblower Omni Healthcare, Inc., which will receive a relator’s share of $150,000 of the settlement.  USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 17, 2021

Following a voluntary self-disclosure to authorities, Blessing Hospital in Quincy, Illinois, has agreed to pay $2.82 million to resolve allegations that it submitted false claims for the facility component of medically unnecessary cardiac catheterization procedures.  The federal government will receive $2.6 million of the settlement, with the remainder going to Illinois, Iowa, and Missouri.  USAO CD IL

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

August 9, 2021

The owners of North Carolina compounding pharmacy Wellcare Compouding, David Tsui and Lois Tsui, paid $1.1 million to resolve allegations that they violated the False Claims Act by submitting false claims for payment to the TRICARE program in 2014 and 2015.  The government alleged that Wellcare made improper payments to physicians and “marketers” in violation of the Anti-Kickback Statute and encouraged medically unnecessary prescriptions consisting of high-margin ingredients in order to maximize the pharmacy’s reimbursement. David Tsui had been convicted of healthcare fraud in 2009 and was excluded from participation in federal healthcare programs; the government alleged that his involvement and ownership was intentionally concealed.  USAO MD NC

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

August 6, 2021

A county in California and a county medical center have agreed to pay $11.4 million to resolve allegations of improperly billing a federal healthcare program between 2013 and 2017.  According to whistleblower Felix Levy, a former employee of San Mateo County Medical Center (SMMC), San Mateo County and SMMC billed Medicare for uncovered hospital stays for patients that were admitted without regard to medical necessity.  USAO NDCA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case,

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