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June 18, 2015

Edward Berman, a physician with a practice in Ridgefield, Connecticut, agreed to pay $218,633 to resolve allegations he violated the False Claims Act by submitting claims to Medicare for skilled nursing facility services that were not performed in accordance with Medicare requirements.  Specifically, the government alleges that Berman “upcoded” certain services, submitting claims to Medicare by using a higher-paying billing code when services with lower-paying billing codes were actually provided.  DOJ

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services.  According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level.  The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care.  DOJ

June 16, 2015

Hebrew Homes Health Network Inc., a Florida-based operator of rehabilitation and skilled nursing facilities, along with its former president and executive director William Zubkoff, agreed to pay $17 million to resolve allegations it violated the False Claims Act by improperly paying doctors for referrals of Medicare patients requiring skilled nursing care.  It is the largest settlement involving alleged violations of the Anti-Kickback Statute by skilled nursing facilities in the US.  The allegations against Hebrew Homes first arose in a whistleblower lawsuit filed by Stephen Beaujon, a former CFO of Hebrew Homes, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $4.25 million.  Whistleblower Insider

June 16, 2015

Jacksonville, Florida-based home health company Advanced Homecare, Inc.agreed to pay $1,293,169 to settle charges it violated the False Claims Act by billing the government for millions of dollars of medically unnecessary services.  According to the government, Advanced Homecare accepted and treated patients who were not actually homebound and did not have a valid physician certification of home health need, as required by Medicare.  The allegations first arose in a whistleblower lawsuit filed by Advanced Homecare former employee Marsha Yandell under the qui tam provisions of the False Claims Act.  Ms. Yandell will receive a whistleblower award of more than $200,000.  DOJ

June 15, 2015

Children’s Hospital, Children’s National Medical Center Inc. and its affiliated entities agreed to pay $12.9 million to resolve allegations they violated the False Claims Act by submitting false cost reports and other applications to the components and contractors of the Department of Health and Human Services, as well as to Virginia and District of Columbia Medicaid programs.  The allegations first arose in a whistleblower lawsuit filed by former Children’s National Medical Center employee James A. Roark Sr. under the qui tam provisions of the False Claims Act.  Mr. Roark will receive a whistleblower award of $1,890,649.98.  DOJ

June 5, 2015

Atlanta-based dental practice Dennis B. Jaffe D.M.D., P.C. and its principal Dennis Jaffe agreed to pay $324,327.05 to settle charges they violated the False Claims Act by fraudulently billing Medicaid for tooth extraction procedures and for fraudulently billing for services rendered by a dental assistant when Jaffe was not present in the office. According to the government, Jaffe fraudulently sought payment from Medicaid for higher and more expensive levels of service than were actually performed, a practice commonly referred to as “upcoding.”  The allegations first arose in a whistleblower lawsuit filed by Michelle Smith under the qui tam provisions of the False Claims Act.  DOJ

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme.  Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit.  Clearview is now owned by Community Health Systems which purchased HMA in January 2014.  According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute.  As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act.  The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $119,031.  DOJ, GA

June 1, 2015

Memphis-based First Tennessee Bank agreed to pay $212.5 million to resolve allegations it — through its subsidiary First Horizon Home Loans Corporation — violated the False Claims Act by originating and underwriting mortgage loans insured by the Department of Housing and Urban Development’s (HUD) Federal Housing Administration (FHA) that did not meet applicable requirements.  Whistleblower Insider

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services.  Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing.  The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC.  The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be determined whistleblower award. DOJ

May 28, 2015

Garden State Cardiovascular Specialists P.C., a New Jersey-based cardiology practice which owns and operates several facilities in New Jersey under the name NJ MedCare/NJ Heart, agreed to pay more than $3.6 million to resolve allegations the company and its principals, Dr. Jasjit Walia and Dr. Preet Randhawa, submitted claims to Medicare for various cardiology diagnostic tests and procedures, including stress tests, cardiac catheterizations and external counterpulsation, which were not medically necessary. The allegations were first raised in a whistleblower lawsuit filed by Cheryl Mazurek under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of more than $648,000.  DOJ
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