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August 2, 2022

Denver Public Schools paid over $2.1 million to resolve a False Claims Act investigation into its misuse of AmeriCorps funds. AmeriCorps funds are used to address critical community needs such as fighting poverty, mentoring youth, and increasing academic achievement. To that end, AmeriCorps provides education awards to their volunteers a/k/a “members” for performing a specified number of service hours in these communities. DPS recruited their existing employees for AmeriCorps programs and double-counted hours spent on their employment duties as being on service, which is disallowed as it deprives the students of the net benefit of the additional support they would have received from non-DPS-employed AmeriCorps members. USAO CO

Tagged in: Education Fraud, FCA Federal, Government Programs Fraud,

August 2, 2022

VE Source LLC and its owners, Sherman Barton and Christopher Neary, as well as a related entity, Vertical Source LLC, have together agreed to pay nearly $8 million to resolve claims of violating the False Claims Act.  VE Source had fraudulently obtained more than $16.5 million in contracts with the Department of Agriculture (USDA) and the Defense Logistics Agency (DLA) that were set aside for businesses owned and controlled by service-disabled veterans, which it was not.  USAO NJ

Tagged in: Certifications, Contract Non-Compliance, FCA Federal, Government Programs Fraud, Set-Asides and Preferences,

July 29, 2022

Old Man’s Home of Philadelphia d/b/a Saunders House, a skilled nursing facility, will pay $819,640 for its violations of the False Claims Act. A whistleblower filed suit under the qui tam provisions of the FCA, alleging Saunders House overbilled federal healthcare programs for therapy services provided; billed for therapy services not provided; billed for unreasonable, unnecessary, and sometimes harmful therapy; and manipulated clinical services to maximize billing. Medicare Part A paid Saunders House based on beneficiaries’ assigned Resource Utilization Group, and Saunders billed at the highest RUG level—Ultra High or RU—despite the lack of reasonableness or necessity for the patients. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, SNF, Upcoding, Whistleblower Case,

July 26, 2022

Mallinckrodt ARD, LLC f/k/a Questcor Pharmaceuticals, Inc. will pay over $233 million over a 7-year period to settle False Claims Act violations, which occurred from January 2013 through June 2020. During this time, Mallinckrodt knowingly underpaid Medicaid rebates on its H.P. Acthar Gel. The practice was exposed by a whistleblower lawsuit originally filed in Massachusetts. Mallinckrodt paid rebates for Achtar in 2013 as if it was a “new drug” rather than one that was introduced to the market in 1952. NJ OAG

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Pharma Fraud, Whistleblower Case,

July 22, 2022

Medical device manufacturer Biotronik Inc. has agreed to pay nearly $13 million to resolve allegations of paying kickbacks to physicians in order to induce use of their implantable cardiac devices, and causing false claims to be submitted to Medicare and Medicaid.  The alleged violations of the Anti-Kickback Statute and False Claims Act were brought to light in a qui tam suit by Jeffrey Bell and Andrew Schmid, both former sales representatives for Biotronik, who as part of the settlement will receive a $2.1 million relator’s share.  USAO CDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

July 22, 2022

Metric Lab Services, LLC, Metric Management Services LLC, Spectrum Diagnostic Labs LLC, and two of their owners, Sherman Kennerson and Jeffrey Madison, will pay $5.7 million to resolve allegations of False Claims Act violations. In their genetic testing fraud scheme, Metric and Spectrum paid kickbacks to certain marketers who solicited generic testing samples from Medicare beneficiaries, with false physician attestations that the testing was medically necessary. Kennerson and Madison both pled guilty to one count of conspiracy to defraud the U.S. and are currently awaiting sentencing. DOJ, NJ USAO

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

July 20, 2022

Texas-based clinical laboratory Inform Diagnostics, Inc., formerly known as Miraca Life Sciences, Inc., has agreed to pay $16 million to resolve allegations of violating the False Claims Act.  Inform admitted that it had a policy of conducting additional tests on biopsy specimens without an individualized determination on whether additional tests were medically necessary, then submitting bills for those unauthorized and unnecessary tests to Medicare and other federal healthcare programs.  USAO MA

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

July 14, 2022

BioReference Health, LLC, formerly known as BioReference Laboratories, Inc. and OPKO Health, Inc., have agreed to pay nearly $10 million and enter into a five-year Corporate Integrity Agreement to settle a whistleblower-brought case alleging it violated the Anti-Kickback Statute, Stark Law, and False Claims Act.  The alleged misconduct involved making lease payments to healthcare providers that exceeded fair market value, and later failing to report or return any overpayments to federal healthcare programs.  USAO MA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

July 13, 2022

Solera Specialty Pharmacy and its CEO, Nicholas Saraniti, has agreed to pay $1.31 million and enter into a three-year integrity agreement to resolve allegations of defrauding Medicare.  Solera allegedly submitted fraudulent claims for Evzio—a high-priced version of naloxone, which reverses opioid overdoses—based on prior authorization requests that contained false clinical information, that were not actually approved by physicians, and that improperly listed Solera’s contact information as if it were the physician’s.  In connection with a criminal information, Solera has also entered into a deferred prosecution agreement.  The whistleblower in this case, a former employee of Evzio manufacturer kaléo Inc. named Rebecca Socol, will receive a $262,000 share of the settlement.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

July 8, 2022

Aerojet Rocketdyne Inc., which provides propulsion and power systems for vehicles belonging to the Department of Defense and NASA, has agreed to pay $9 million to resolve a whistleblower lawsuit.  According to Brian Markus, a former employee, the company misrepresented its compliance with the cybersecurity requirements of contracts with those agencies, in violation of the False Claims Act.  For bringing a successful qui tam case, Markus will receive a relator’s share of $2.61 million.  USAO EDCA

Tagged in: Certifications, Cybersecurity and Data Breaches, Defense Contract Fraud, FCA Federal, Whistleblower Case, Whistleblower Rewards,

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