Archive

June 25, 2020

George Philip Tompkins of Houston, Texas, the former owner of Piney Point Pharmacy, was sentenced to ten years in prison following his conviction on charges of healthcare fraud, unlawful kickbacks, money laundering, and wire fraud. Tompkins billed $21.8 million to federal and state worker’s compensation programs for medically unnecessary compound gels and creams, paying kickbacks to generate prescriptions while claiming that the kickbacks were legitimate marketing expenses. Thompson was also ordered to pay restitution of $12.3 million. DOJ

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Criminal Proceedings, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

June 24, 2020

Augusta University Medical Center (AUMC) has agreed to pay $2.6 million to resolve fraud allegations by the United States, State of Georgia, and State of South Carolina under state and federal False Claims Acts. According to the government, AUMC knowingly submitted claims to Medicare and Medicaid for a medically unnecessary procedure that was billed as a covered procedure. USAO SDGA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

June 16, 2020

A doctor in Mississippi has been sentenced to four years in prison and ordered to pay nearly $5 million in restitution and judgment for committing healthcare fraud against multiple insurers, including TRICARE. In exchange for a 35% cut of reimbursements, Dr. Shahjahan Sultan had agreed to enter into a contract with a local pharmacy to prescribe expensive compound medications to insured patients, which he did without regard to medical necessity, and which resulted in over $8 million in losses to insurers. USAO SDMS

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

May 7, 2020

Seattle Pain Center, Northwest Analytics, and owner/physician Dr. Frank Danger Li have agreed to pay $2.85 million to settle allegations of defrauding Washington’s Medicaid program. An investigation revealed that between 2013 and 2015, Li had instituted a policy required nearly every patient treated at Seattle Pain Center to be administered the full urine drug panel at each visit even if they were not medically necessary. The drug tests were then sent to Li’s exclusively-owned laboratory to be analyzed. Additionally, the investigation revealed that between 2007 and 2016, Li wrote an excessive amount of prescriptions for opioids, and at least 60 of his patients died due to opioid-related causes during this period. AG WA; USAO WDWA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Provider Fraud,

May 1, 2020

Milwaukee-based Center for Pain Management, S.C. and its owner, Nosheen Hasan, will pay at least $1.35 million to resolve claims that they received unlawful kickbacks in exchange for ordering medically unnecessary tests from a urine drug testing laboratory, Midwest Laboratory Sales & Consulting, LLC, in violation of the False Claims Act. The investigation was initiated by a whistleblower, who will receive a share of the settlement. USAO ED WI

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

April 29, 2020

North Carolina physician Ibrahim Oudeh and his wife Teresa Sloan-Oudeh will pay up to $8.8 million to resolve claims of Medicare and Medicaid fraud. Between 2010 and 2017, the Oudehs reportedly submitted more than 40,000 false claims, including more than 37,000 claims for laboratory tests, including nerve-conduction studies that Dr. Oudeh was not qualified to interpret, the vast majority of which were medically unnecessary. To submit as many claims as they did, defendants falsely billed for office visits, in some instances billing for more than 24 hours of visits in a single calendar day. The Oudehs sometimes used outside physicians to interpret laboratory tests, but paid those physicians less than their practice’s Medicare reimbursement, a violation of the Anti-Markup Rule. Defendants will forfeit $3.3 million in assets and pay an additional $5.5 million. USAO EDNC; NC

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

April 27, 2020

North Carolina based clinical laboratory Genova Diagnostics Inc. will pay up to $43 million to resolve a lawsuit brought by whistleblower Darryl Landis, who will receive up to $6 million. The laboratory allegedly billed Medicare, TRICARE, and other government healthcare programs for IgG allergen, “NutrEval,” and “GI Effects” lab tests that were not medically necessary, and also paid unlawful compensation to three phlebotomy vendors in violation of the Stark Law The settlement amount consists of the forfeiture of $17 million in claim funds held in suspension by Medicare and TRICARE, as well as an additional $26 million to be paid based on certain financial contingencies over the next five years. DOJ; USAO WD NC

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

April 15, 2020

A Florida-based reference laboratory, pain clinic, and two former executives have agreed to pay $41 million to settle claims of defrauding Medicaid, Medicare, TRICARE, and other government health programs by billing for medically unnecessary urine drug tests between 2010 to 2017. Led by Michael T. Doyle and Christopher Utz Toepke, the defendants allegedly had a policy of automatically ordering both presumptive and definitive urine drug tests for all patients at every visit regardless of need, with Toepke’s Tampa Pain Relief Centers Inc. performing all presumptive tests, and Doyle’s Logan Laboratories Inc. performing all definitive tests. The alleged False Claims Act violations were eventually brought to light in two qui tam cases; the whistleblowers of those cases will split a relator’s share of approximately $7.79 million. DOJ; EDPA; MDFL; FL

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

April 14, 2020

A chain of nine skilled nursing facilities operating in seven states has agreed to pay $10 million to settle a whistleblower-brought suit alleging violations of the False Claims Act. In the suit, former employees Hope Wright, Laura Webb, and Deborah Edmonds alleged that from 2013 to 2017, Saber Healthcare Group LLC improperly pressured therapists to provide Ultra High levels of rehabilitation therapy for all patients regardless of individual patient needs. Ultra High levels of therapy involve a minimum of 720 minutes of therapy from two therapy disciplines, and are reimbursed at the highest rate possible by Medicare. To enforce their illegal standard, Saber prevented therapists from providing lower levels of therapy, caused therapists to falsely report time, and pressured facility directors in daily or weekly calls. As part of the settlement, Saber has agreed to a five year Corporate Integrity Agreement, and Wright, Webb, and Edmonds will receive $1.75 million of the settlement proceeds. DOJ

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

April 10, 2020

To settle fraud allegations by four relators in three qui tam suits, Michigan-based Encore Rehabilitation Services LLC has agreed to pay $4 million to the United States. According to Linda Anderson, Reza Saffarian and Audrey Theile, and Adam LaFerriere, from roughly 2010 to 2018, the owner and operator of over 600 healthcare facilities allegedly caused three of its skilled nursing facilities to submit false claims to Medicare for services that were not medically necessary, reasonable, or provided by skilled therapists, and improperly billed group therapy sessions as if they were individual therapy sessions. DOJ; USAO EDMI; USAO WDMI

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

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