Archive

October 21, 2020

Purdue Pharma LP agreed to criminal fines and forfeitures totaling $5.544 billion following its guilty plea on charges arising from its manufacture and sale of opioid products. Purdue falsely represented to the DEA that they maintained an effective anti-diversion program while continuing to market opioid products to healthcare providers that it had reason to believe were diverting opioids, aided and abetted the dispensing of opioids without a legitimate medical purpose, paid doctors to induce them to prescribe Purdue’s products, and paid an EHR company to boost the presence of Purdue’s products on the EHR system. Purdue will receive a credit of up to $1.775 billion based on its prior settlements with state and local entities. In addition to the criminal fines and forfeitures, a civil settlement provides the U.S. with an allowed claim of $2.8 billion to resolve claims that the company caused the submission of false claims to federal healthcare programs. Individual members of the Sackler family, which owns Purdue, separately agreed to pay $225 million to resolve claims arising from their approval of a marketing program aimed at extreme high-volume prescribers and their transfer of assets into Sackler family holding companies and trusts. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Lack of Medical Necessity, Pharma Fraud,

October 16, 2020

Massachusetts home health agency Altranais Home Care, LLC and its owners, Constant Ogutt and Shakira Lubega, will pay $3.1 million to resolved claims that they submitted false claims to the state’s Medicaid program, MassHealth. According to the state, the defendants billed for services for which they did not have a physician-authorized plan of care. Mass

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

October 2, 2020

Advanced Pain Management Holdings, Inc. and its subsidiaries will pay $1 million to resolve claims brought by a whistleblower under the False Claims Act. Defendants, which run ambulatory surgical centers, were alleged to have violated the Anti-Kickback Statute by improperly gifting incentive stock shares to non-employee physicians allegedly as a reward for past and anticipated referrals to APMH facilities, and by paying those physicians “medical director” fees tied to the volume of procedures at APMH facilities, without proper documentation of the agreement. In addition, defendants were alleged to have performed unnecessary confirmatory urine drug testing on patients. USAO ED WI

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

September 29, 2020

Laredo optometrist David Mora will pay $3.23 million and enter into a corporate integrity agreement to resolve claims that he submitted false claims to Medicare between 2013 and 2019. Mora allegedly billed for services including punctal plug insertion, sensorimotor testing, vision therapy, and amniotic membrane placement, where the patient’s condition did not warrant the service as medically necessary or reasonable. USAO SD TX

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

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

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding,

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

Tagged in: Criminal Proceedings, Defective Products, FCA Federal, Lack of Medical Necessity, Multiple Whistleblowers and First-to-File, Pharma Fraud, Whistleblower Case,

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

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

July 13, 2020

Longwood Management Company and 27 affiliated skilled nursing facilities have agreed to pay $16.7 million to resolve allegations raised by whistleblowers Judy Boyce, Benjamin Monsod, and Keith Pennetti in two separate qui tam filings, that six Longwood facilities knowingly submitted false claims to Medicare. Between 2018 to 2012, Longwood allegedly pressured its rehabilitation therapists to increase the amount of therapy provided to Medicare Part A patients, regardless of medical necessity, so it could claim Ultra High levels of service, which are reimbursed at the highest rate. As part of the settlement, Longwood will enter into a five-year Corporate Integrity Agreement, and Boyce, Monsod, and Pennetti will share a $3 million award. DOJ; USDC CDCA

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

July 10, 2020

Universal Health Services, Inc. and UHS of Delaware, Inc. (collectively, UHS), and a Georgia-based UHS facility, Turning Point Care Center, LLC, have agreed to pay a combined $122 million to settle 18 qui tam cases pending in four jurisdictions. In violation of the False Claims Act, UHS allegedly billed federal healthcare programs—including Medicare, Medicaid, TRICARE, the Department of Veteran Affairs, and the Federal Employee Health Benefit programs—for medically unnecessary inpatient behavioral health services, failed to provide adequate or appropriate services, and paid illegal inducements to beneficiaries of those programs. UHS will pay over $88 million to the federal government and nearly $29 million to individual states, for a combined penalty of $117 million, with a relator share of about $15.8 million. Turning Point will pay $5 million to the federal government and the State of Georgia; the whistleblower in that case will receive $861,853.64. USAO MDFL; USAO NDGA; USAO EDPA; AG FL; AG MI; AG NC; AG VA

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

July 8, 2020

A Florida-based nonprofit that provides hospice care, palliative care, and other services to the elderly, has agreed to pay $3.2 million to resolve its liability under the False Claims Act. According to former Director of Hospice Care, Margaret Peters, Hope Hospice knowingly submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary but highly reimbursed general inpatient (GIP) hospice services over a five year period. For blowing the whistle on the alleged fraud, Peters will receive a 19% share of the settlement. USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, SNF, Whistleblower Case, Whistleblower Rewards,

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