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May 27, 2015

Durable medical equipment suppliers Orbit Medical Inc. and its partial successor, Rehab Medical Inc., agreed to pay $7.5 million to settle False Claims Act charges that Orbit submitted false claims to federal health care programs for power wheelchairs and accessories.  According to the government, Orbit sales representatives knowingly altered physician prescriptions and supporting documentation to get Orbit’s power wheelchair and accessory claims paid by Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency.  The allegations were first raised in a whistleblower lawsuit filed by former Orbit employees Dustin Clyde and Tyler Jackson under the qui tam provisions of the False Claims Act.  They collectively will receive a whistleblower award of approximately $1.5 million.  Whistleblower Insider

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

May 20, 2015

Pharmacy benefits manager Medco Health Solutions Inc., a wholly-owned subsidiary of the pharmacy benefit manager Express Scripts Holding Company, agreed to pay $7.9 million to settle allegations it engaged in a kickback scheme in violation of the False Claims Act.  According to the government, Medco solicited remuneration from AstraZeneca in exchange for identifying Nexium as the “sole and exclusive” proton pump inhibitor on certain of Medco’s prescription drug lists known as formularies.  AstraZeneca allegedly compensated Medco in the form of reduced prices on the following AstraZeneca drugs: Prilosec, Toprol XL and Plendil.  In January 2015, the government reached a $7.9 million settlement with AstraZeneca to resolve kickback allegations arising out of the same conduct.  The allegations first arose in a whistleblower lawsuit filed by former AstraZeneca employees Paul DiMattia and F. Folger Tuggle under the qui tam provisions of the False Claims Act.  They will receive a whistleblower reward from the recovery that has yet to be determined.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

May 20, 2015

Florida-based neurologist Dr. Sean Orr agreed to pay $150,000 to settle allegations he violated the False Claims Act by providing medically unnecessary services and drugs to federal health care program beneficiaries.  According to the government, from September 2009 to April 2012 Orr knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal health care programs to be billed for medically unnecessary services and drugs.  In 2014, the government settled related allegations against Baptist Health System Inc. – Orr’s former employer and the parent company for Baptist Neurology Inc. and Baptist Medical Center-Jacksonville – for $2.5 million.  The allegations first arose in a whistleblower lawsuit filed by former Baptist Neurology employee Verchetta Wells under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $26,250.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 19, 2015

Atlanta-based world-wide package delivery service United Parcel Service agreed to pay $25 million to resolve allegations it violated the False Claims Act by submitting false claims to the federal government in connection with its delivery of Next Day Air overnight packages.  According to the government, UPS engaged in multiple practices to conceal its failure to comply with its delivery guarantees, thereby depriving federal customers of the ability to request refunds for late deliveries.  The government’s allegations arose out of whistleblower lawsuit filed by former UPS employee Robert K. Fulk under the qui tam provisions of the False Claims Act.  Mr. Fulk will receive a whistleblower award of $3.75 million.  DOJ

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

May 14, 2015

Westchester County Health Care Corporation (d/b/a Westchester Medical Center) agreed to pay $18.8 million to settle charges it violated the False Claims Act, the Anti-Kickback Statute and the Stark Law.  According to the government, from approximately 2000 through 2007, WMC maintained a financial relationship with Cardiology Consultants of Westchester, P.C., a cardiology practice formerly operating on WMC’s Valhalla campus.  WMC allegedly advanced monies to CCW to open a practice for the express purpose of generating referrals to the hospital.  When CCW began making payments to WMC purportedly repaying the advances, WMC entered into retroactive, no-work consulting agreements under which it paid CCW tens of thousands of dollars.  WMC also allegedly allowed CCW to use WMC’s fellows in CCW’s private office free of charge, contrary to WMC’s historic practice.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud,

May 14, 2015

PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country, agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs.  The government’s allegations against PharMerica arose out of whistleblower lawsuit brought by Jennifer Denk, a pharmacist formerly employed by PharMerica, under the qui tam provisions of the False Claims Act.  Ms. Denk will receive a whistleblower award of $4.3 million.  Whistleblower Insider

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

May 13, 2015

Healthcare technology company Siemens Medical Solutions USA, Inc. agreed to pay $5.9 million to resolve False Claims Act charges of overcharging the Department of Defense for purchases of medical imaging equipment.  DOJ

Tagged in: Contract Non-Compliance, Defense Contract Fraud, FCA Federal,

May 7, 2015

Health Management Associates Inc. (and 14 hospitals it previously owned), along with Community Health Systems and North Texas Medical Center, agreed to collectively pay $15.69 million to settle whistleblower charges they violated the False Claims Act by seeking and receiving Medicare reimbursement for Intensive Outpatient Psychotherapy (IOP) services that were not medically reasonable or necessary.  The IOP services in question were typically performed on the providers’ behalf by Louisiana-based Allegiance Health Management.  The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The unidentified whistleblower will receive a whistleblower award of $2,667,300.  Whistleblower Insider

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

May 7, 2015

Tennessee-based Jackson-Madison County General Hospital agreed to pay $1,328,465 to resolve allegations it improperly billed Medicare and Medicaid for the placement of unnecessary cardiac stents and other unnecessary cardiac procedures including angioplasty, catheterization, and ultrasound imaging.  The allegations were first raised in a whistleblower lawsuit filed by Dr. Wood D. Deming under the qui tam provisions of the False Claims Act.  Mr. Deming will receive an undisclosed portion of the settlement as a whistleblower award.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

May 1, 2015

Accredo Health Group, a unit of Express Scripts Holding Co., agreed to pay $60 million to settle False Claims Act and Anti-Kickback Statute charges that the company participated in a kickback scheme with Novartis Pharmaceuticals Corp. involving the prescription drug Exjade.  According to the government, Novartis provided kickbacks, in the form of patient referrals and related benefits, to Accredo in exchange for Accredo recommending refills to Exjade patients.  The government also intervened in a whistleblower lawsuit against Novartis for the same alleged scheme.  The government claims defendants allegedly understated the serious and potentially life-threatening side effects of Exjade when promoting the drug’s benefits to patients. FBI

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud,

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