Archive

March 17, 2016

Carlos Medina, owner of Miami-area medical clinics Doral Community Clinic Inc. and Advanced Medical of Doral Inc. was sentenced to 82 months in prison for his role in a Medicare fraud scheme that caused more than $3 million in losses.  The clinics purportedly provided medically necessary services to Medicare beneficiaries, but in reality charged cash kickbacks in exchange for prescriptions for home health care services.  Some of the beneficiaries who frequented the clinics did not meet Medicare’s criteria for the prescribed services and some of the services prescribed by the medical professionals at Doral and Advanced Medical were never provided by the home health agencies to which the patients were referred.  DOJ

March 15, 2016

Tennessee-based Southern Tennessee Medical Center agreed to pay roughly $2.5 million to settle charges it violated the False Claims Act by submitting Medicare claims for medically unnecessary days of in-patient geriatric psychiatric services and in-patient geriatric psychiatric services for which a Physician Certification or Recertification was not obtained.  DOJ (MDTN)

March 8, 2016

21st Century Oncology Inc., the nation’s largest physician led integrated cancer care provider, and its wholly owned subsidiary South Florida Radiation Oncology agreed to pay $34.7 million to settle charges they violated the False Claims Act by performing and billing for cancer care procedures that were not medically necessary or properly provided. According to the government, the companies improperly billed for Gamma function procedures — which measure radiation doses — under circumstances where there was no medically appropriate purpose for the treatment.  The allegations leading to the settlement originated in a whistleblower lawsuit filed by Joseph Ting, a former physicist at South Florida Radiation Oncology, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of more than $7 million from the proceeds of the government’s recovery.  This settlement follows on the heels of the $19.75 million settlement 21st Century Oncology Inc. subsidiary 21st Century Oncology LLC agreed to pay in December to settle charges of billing for medically unnecessary laboratory urine tests and for paying kickbacks to encourage physicians to order the tests.  Whistleblower Insider

March 7, 2016

Florida businessman David Brock Lovelace was sentenced to 174 months in prison and to pay $2,512,460 in restitution for his role in a multimillion-dollar health care fraud and money laundering scheme.  According to evidence presented at trial, Lovelace and co-conspirators used Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists, three purported medical clinics in Florida, to submit to Medicare more than $12 million in fraudulent claims for radiology, audiology, cardiology and neurology services not rendered by physicians, secured by kickbacks or the subject of forged or falsified documents.  DOJ

March 9, 2016

Florida arrested a couple for defrauding the Medicaid program out of more than $180,000 in fraudulent claims. Oscar Alzate, 48, and Alba Garcia, 48, owners of Digital Radiology Center, Inc. and Medisound, Inc., allegedly operated a clinic without the appropriate licensure or proper oversight by a physician as required by Florida law. The investigation revealed that Alzate and his partner Garcia, neither who are physicians, billed the Medicaid program for services never rendered. The clinic owners also allegedly forged physicians’ signatures on medical reports and provided defective mammography services. FL

March 8, 2016

A Connecticut psychiatrist will pay $404,798 to settle a civil False Claims Act lawsuit alleging that she submitted false claims for payments to Connecticut’s Medicaid program. The state alleged that, from March 2010 to September 2013, while operating a private practice in Mansfield, Dr. Panoor submitted upcoded claims indicating that she provided Medicaid patients with both group counseling and either individual psychotherapy or a detailed examination on the same dates of service when, in fact, she did not provide psychotherapy or detailed examination sessions but instead provided medication management services or a brief meeting with the patient for the purpose of monitoring or changing a patient’s drug prescription – services that are coded, and thus reimbursed, at lower payment rates.

March 2, 2016

Mark T. Conklin, the former owner and operator of Florida-based Recovery Home Care Inc. and Recovery Home Care Services Inc. (RHC) agreed to pay $1.75 million to resolve charges of violating the False Claims Act by paying illegal kickbacks to doctors who agreed to refer Medicare patients to RHC for home health care services.  Conklin sold RHC to National Home Care Holdings in October 2012.   According to the government, Conklin ran a scheme under which RHC paid dozens of physicians thousands of dollars per month to serve as sham medical directors who performed little or no work in exchange for referring their patients to RHC.  The allegations originated in a whistleblower lawsuit filed by former RHC employee Gregory Simony under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of up to $315,000 from the proceeds of the government's recovery.  DOJ

March 1, 2016

Ubert Guillermo Rodriguez, president and owner of Florida-based durable equipment provider G.R. Services Equipment & Supplies Inc., pleaded guilty to conspiracy to commit health care fraud.  According to the government, Rodriguez’s company submitted approximately $2.6 million worth of claims to Medicare seeking reimbursement for durable medical equipment, such as wound care supplies, that was not legitimately prescribed by doctors and was not provided to beneficiaries.  DOJ

March 1, 2016

Olympus Corp. of America, the country’s largest distributor of endoscopes and related equipment, agreed to pay $623.2 million to resolve alleged violations of the False Claims Act and Anti-Kickback Statute through a scheme to pay kickbacks to doctors and hospitals.  It is the largest payout ever by a medical device company for violations of the Anti-Kickback Statute.  In addition, Olympus subsidiary Olympus Latin America Inc. also agreed to pay $22.8 million to resolve separate charges relating to violations of the Foreign Corrupt Practices Act.  The allegations originated in a whistleblower lawsuit filed by John Slowik, Olympus’ former chief compliance officer, under the qui tam provisions of the federal and various state False Claims Acts.  He will receive a whistleblower award of roughly $51 million from the proceeds of the government’s recovery.  Whistleblower Insider

March 3, 2016

New York announced an agreement with Endo Health Solutions Inc. and Endo Pharmaceuticals Inc. (“Endo”), which make and sell the long-acting opioid, Opana ER. The agreement requires Endo to cease all misrepresentations regarding the properties of Opana ER, to describe accurately the risk of addiction to Opana ER, and to summarize studies regarding Opana ER on its website. Endo must also create a program that will prevent its sales staff from promoting this powerful narcotic painkiller to health care providers who may be involved in the abuse and illegal diversion of opioids. Endo, an Irish company with U.S. headquarters in Pennsylvania, makes a variety of prescription drugs. Endo’s opioid drug Opana ER has been widely abused in New York State. NY