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August 10, 2022

American Senior Communities, L.L.C., will pay over $5.5 million for violating the False Claims Act by charging Medicare directly for hospice services that should have already been covered by the beneficiaries’ Medicare hospice coverage. The fraudulent billing practice was exposed in a whistleblower complaint filed by a former employee of a hospice services provider that worked with ASC. The whistleblower is entitled to receive between 15 and 25% of the recovery. USAO SDIN

August 5, 2022

Gonzaga Interventional Pain Management, Melvin Gonzaga, M.D., and his son Rommel Gonzaga will pay $980,000 for violating the False Claims Act by submitting claims for medically unnecessary urine drug tests. GIPM required patients to submit a UDT sample before being seen by a provider and discussing the results from any prior UDT the patient received. Regardless of the patients’ individualized testing needs, GIPM always opted for the more complex “definitive” UDT rather than the lower-level “presumptive” UDT, netting a higher reimbursement rate from the US government. USAO MD

August 4, 2022

Eastern Iowa Dermatology, PLC and Dr. Manish Kumar will pay $1.66 million for violating the False Claims Act. Defendants submitted up-coded claims to Medicare for office visits and destruction or removal of skin tags and lesions, the sole purpose of which is to increase Medicare’s reimbursement rate. In addition to the monetary penalty, they agreed to an Integrity Agreement and are subject to ongoing monitoring by the US DHHS. USAO SDIA

August 3, 2022

North Country Neurology, P.C. will pay $850,000 for violating the False Claims Act by submitting claims falsely listing a physician as the service provider, when the services were provided instead by an unsupervised non-physician practitioner. Medicare will reimburse for certain services provided by NPPs, but require a physician to be physically present in the office and immediately available to furnish assistance. This was not the case on over 120 occasions, and NCN admitted it should have known it was improper to bill at the higher physician rather than NPP level. Additionally, NCN improperly billed Medicare on approximately 761 occasions for Botox, even though it had already been paid for by another insurer. NCN blamed their insufficient compliance program for the errors. USAO NDNY

August 3, 2022

Dunn Meadow LLC dba Dunn Meadow Pharmacy, pleaded guilty to illegally distributing prescription fentanyl and paying kickbacks to healthcare providers, in violation of the False Claims Act and the Controlled Substances Act. From 2015 through 2019, Dunn Meadow filled prescriptions not written for a legitimate medical purpose, including those for patients exhibiting suspicious drug-seeking behavior (i.e., requesting prescriptions be sent to suspicious or inappropriate locations including hotels, casinos, and elementary schools). These actions caused a $4.5 million loss to the federal government. Dunn Meadow will pay up to $50 million over the next five years to resolve its civil liability if it generates future revenue. USAO NJ

July 29, 2022

Allergan will pay up to $2.27 billion to settle allegations they deceptively marketed opioids by downplaying the risks of opioid addiction and instead touting exaggerated benefits from the drugs. Rather than encouraging alternative treatments, Allergan encouraged doctors to prescribe more opioids, and failed to maintain effective controls to prevent diversion of opioids. This settlement involves multiple states, excluding New York, which settled separately with Allergan. VA OAG

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

July 27, 2022

ca Glenn Pair and Markuetric Stringfellow will spend 70 and 78 months in prison, respectively, and pay over $5 million each in restitution for defrauding three States’ Medicaid programs of more than $5 million, and for receiving $1.8 million in kickbacks from participating laboratories. The two owned and operated Do-It-4-The Hood Corporation in North Carolina and later expanded to Georgia. They targeted Medicare-eligible children, enrolled them in their programs, and required them to submit urine specimens for drug testing. Drug testing was in turn billed to Medicaid by complicit laboratories, who then paid kickbacks after receiving Medicaid reimbursement. Through their Wrights Care Services LLC franchise in South Carolina, the two filed fraudulent Medicaid claims for mental health counseling, going so far as to host a “note party,” upon learning of a Medicare audit of Wrights Care, to cover up their scheme by creating false billing records to substantiate their fraudulent Medicaid claims. USAO WDNC, USAO SC

July 26, 2022

Dr. Don Flanagan, D.D.S. and his companies Dental Center, Inc. and Dental Center, P.C. d/b/a Cloudland Dental, will pay $1.5 million for submitting or causing to be submitted claims for payment by falsely identifying Dr. Flanagan as the credentialed physician rendering services. TennCare requires dentists to be credentialed as part of the approval process for billing, yet, from January 2015 through February 2019, services were rendered by uncredentialed dentists, which is a violation of the Tennessee Medicaid False Claims Act. EDTN USAO

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
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