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May 11, 2017

Benefits management company Carecore National LLC agreed to pay $54 million to settle charges of violating the False Claims Act by submitting Medicare and Medicaid claims for medical diagnostic procedures without properly assessing whether they were necessary or reasonable.  CareCore provides utilization management services including determinations of medical necessity to New York Medicaid Managed Care Organizations (MCOs). The agreement settles allegations that CareCore instituted a scheme to auto-approve or “Process As Directed” (“PAD”) hundreds of radiology service requests on a daily basis, deeming those diagnostic services as reasonable and medically necessary, even though there had been no evaluation of those cases by the appropriate medical personnel. Of the $54 million, $18 million will go to 20 state Medicaid programs. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (SDNY); NY, FL

Tagged in: FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

May 1, 2017

Memphis-based Poplar Healthcare PLLC and Poplar Healthcare Management, LLC agreed to pay $897,640 to resolve allegations they violated the False Claims Act by billing the government directly and through a subsidiary known as GI Pathology for diagnostic tests not medically necessary. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Poplar pathologist Gordon Wang. He will receive a whistleblower award of roughly $206,000 from the proceeds of the government's recovery. DOJ (DRI)

Tagged in: FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

April 28, 2017

New Jersey-based Quest Diagnostics Inc. agreed to pay $6 million to resolve charges that Berkeley HeartLab Inc., which Quest acquired in 2011, violated the False Claims Act by paying kickbacks to physicians and patients to induce the use of Berkeley for blood testing services and by charging for medically unnecessary tests. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Michael Mayes. He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

April 10, 2017

Kentucky based nursing home operator Prestige Healthcare agreed to pay $995,500 to resolve allegations it violated the False Claims Act with regard to its role in an alleged scheme to falsely bill Medicare for unnecessary genetic testing.  According to the government, Prestige provided genetic testing company Genomix LLC with information on and access to Prestige nursing home patients without ensuring physician orders were obtained for the testing and where Prestige physicians were not aware of and did not agree with the medical necessity of the testing. DOJ (WDWI)

Tagged in: FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, SNF,

February 1, 2017

Florida urologist Dr. Meir Daller agreed to pay $3.81 million to resolve allegations he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary.  Dr. Meir practices as part of Gulfstream Urology, a division of 21st Century Oncology, LLC, which is a nationwide provider of integrated cancer care services.  The government previously entered into settlements relating to similar allegations with 21st Century Oncology for $19.75 million and urologists David Spellberg and Robert Scappa for $1,050,000 and $250,000, respectively.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Mariela Barnes, a former medical assistant for Dr. Spellberg at Naples Urology Associates, also a division of 21st Century Oncology.  She will receive a whistleblower award of $571,500 from the proceeds of the government's recovery in this settlement.  This is in addition to a $3,437,000 million award she already received from the prior settlements.  DOJ (MDFL)

Tagged in: FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

December 28, 2016

Bay Sleep Clinic, its related businesses -- Qualium Corporation and Amerimed Corporation -- and their owners and operators, Anooshiravan Mostowfipour and Tara Nader, agreed to pay $2.6 million to settle allegations they fraudulently charged Medicare for diagnostic sleep tests and medical devices in violation of Medicare payment rules. The allegations originated in a whistleblower lawsuit filed by Elma F. Dresser under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of approximately $545,000 from the proceeds of the government's recovery. DOJ (NDCA)

Tagged in: Healthcare Fraud, Improper Medical Facility, Improper Medical Personnel, Laboratory and IDTF, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 13, 2016

Elite Lab Services, LLC, along with its husband-and-wife owners Gerard and Suzanne Dengler, agreed to pay $3.75 million to settle charges of their violating the False Claims Act through their billing Medicare for tens of thousands of miles that were never driven by Elite Lab’s personnel.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Elite Lab employee Karen Malcolm.  She will receive a whistleblower award of $787,500 from the proceeds of the government's recovery.  DOJ (EDTX)

Tagged in: FCA Federal, Laboratory and IDTF, Medicare, Whistleblower Case, Whistleblower Rewards,

July 22, 2016

Preferred Imaging, LLC, a provider of diagnostic imaging services, agreed to pay $3,510,000 to resolve allegations it violated the False Claims Act by improperly billing Medicare and Texas Medicaid for services performed without proper medical supervision.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Preferred Imaging employee Tracy Sifuentes.  She will receive a whistleblower award of $596,700 from the proceeds of the government's recovery.  DOJ (NDTX)

Tagged in: FCA Federal, Improper Medical Personnel, Laboratory and IDTF, Medicare, Whistleblower Case, Whistleblower Rewards,

July 12, 2016

New Jersey couple Nita and Kirtish Patel and their diagnostic imaging companies Biosound Medical Services Inc. and Heart Solution PC were ordered to pay more than $7.75 million for violating the False Claims Act by submitting false claims to Medicare for thousands of falsified diagnostic test reports and the underlying tests.  The government had alleged that defendants created fraudulent diagnostic test reports, forged physician signatures on these reports, and then billed Medicare for the fraudulent reports and the underlying tests that were used solely to create these reports.  The government further alleged that defendants billed Medicare for neurological tests that they conducted without the required physician supervision.  The allegations originated in a whistleblower lawsuit filed by a former Biosound employee under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (DNJ)

Tagged in: FCA Federal, Laboratory and IDTF, Medicare, Whistleblower Case, Whistleblower Rewards,

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