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October 22, 2020

Jerry Taylor of North Carolina has been sentenced to five years in prison and ordered to pay more than $6.1 million in restitution for his role in a $9.4 million fraud scheme targeting North Carolina’s Medicaid program.  Along with his brother Tony and co-conspirators in Ohio and New York, Taylor submitted claims for behavioral health services benefiting local at-risk youth that were purportedly performed at companies he owned and operated with his brother, but that were in reality not actually performed or misrepresented in the claims.  In addition to defrauding Medicaid, Taylor also evaded taxes by failing to report more than $1.6 million in reimbursements in 2016 and 2017.  For those charges, Taylor will pay over $346,000 to the IRS.  USAO WDNC

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Misrepresentations, Provider Fraud, Tax Fraud,

October 2, 2020

Advanced Pain Management Holdings, Inc. and its subsidiaries will pay $1 million to resolve claims brought by a whistleblower under the False Claims Act.  Defendants, which run ambulatory surgical centers, were alleged to have violated the Anti-Kickback Statute by improperly gifting incentive stock shares to non-employee physicians allegedly as a reward for past and anticipated referrals to APMH facilities, and by paying those physicians “medical director” fees tied to the volume of procedures at APMH facilities, without proper documentation of the agreement.  In addition, defendants were alleged to have performed unnecessary confirmatory urine drug testing on patients.  USAO ED WI

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

September 29, 2020

Laredo optometrist David Mora will pay $3.23 million and enter into a corporate integrity agreement to resolve claims that he submitted false claims to Medicare between 2013 and 2019.  Mora allegedly billed for services including punctal plug insertion, sensorimotor testing, vision therapy, and amniotic membrane placement, where the patient’s condition did not warrant the service as medically necessary or reasonable.  USAO SD TX

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

September 21, 2020

Neurosurgical Care LLC, its medical director Sagi Kuznits, and its practice director Pnina Kuznits, will pay over $1 million to resolve claims that they overbilled Medicare, TRICARE, and the Federal Employees Health Benefits Program, for the implantation of neuro-stimulators.  Defendants improperly billed the non-surgical application of P-Stim and Stivax devices as surgical procedures, and improperly billed for the application of an eVox device which was not approved for Medicare reimbursement.  USAO ED PA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Off-Label and Unapproved Use, Provider Fraud,

September 9, 2020

Southern California radiology facility operators William M. Kelly Inc. and Omega Imaging Inc. paid $5 million to resolve claims initiated by a qui tam action under the False Claims Act filed by former employee Syd Ackerman.  The action alleged that defendants submitted claims for CT scans and MRIs involving contrast injections that were not supervised by a physician as required by applicable program rules.  The whistleblower will receive $925,000 of the settlement.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

September 9, 2020

West Virginia-based acute care hospital, Wheeling Hospital, Inc., has agreed to pay $50 million to resolve claims of violating the Anti-Kickback Statute, Physician Self-Referral (Stark) Law, and False Claims Act.  According to a former executive turned whistleblower, Louis Longo, Wheeling knowingly provided referring physicians with compensation above fair market value, based on the volume or value of their referrals, then submitted claims resulting from those improper referrals to Medicare.  As part of the settlement, Longo will receive a $10 million relator’s share.  DOJ; USAO WDPA; USAO NDWV

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

September 3, 2020

Having previously pleaded guilty to healthcare fraud and related charges, Arizona urgent care provider UCXtra Umbrella, LLC, which did business as "Urgent Care Extra," was sentenced to pay restitution of $12.5 million.  Defendant admitted that it ordered tests and procedures that were not medically necessary and that its billings intentionally overstated the complexity of services to patients in order to receive inflated reimbursements from private insurance companies. USAO AZ

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding,

August 31, 2020

Brooklyn, New York resident Aleksander Pikus was sentenced to 13 years in prison and ordered to pay $39.4 million in restitution and forfeit $2.6 million following his conviction at trial for charges related to a kickback and tax avoidance scheme involving a number of medical clinics in Brooklyn and Queens.  Pikus referred patients to the clinics, receiving kickbacks in exchange, which he used to pay patient recruiters and patients themselves.  Pikus used shell companies and fake invoices to conceal his scheme and failed to report cash income to the IRS.  DOJ; USAO ED NY

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Provider Fraud,

August 21, 2020

Cardiologist Ghanshyam Bhambhani of Queens, New York, paid $2 million to settle allegations that he paid kickbacks to fellow physicians for patient referrals.  Specifically, defendant was alleged to have paid other doctors compensation disguised as rent for patient referrals in violation of the Anti-Kickback Statute and the False Claims Act, and falsified records to justify cardiac procedures.  The action was initiated by the filing of a whistleblower complaint.  USAO ED NY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Case,

August 21, 2020

A Georgia-based chiropractor and her medical practice have been ordered to pay more than $5 million for violating the False Claims Act.  The government alleged that Dr. Jennifer Heller, D.C. caused Medicare to pay $1.4 million more than it would have had it known that hundreds of Heller’s charges for a surgical neurostimulator procedure were in actuality for acupuncture devices, which are not covered by Medicare, and which do not require surgery.  To resolve the charges, Heller Family Medicine, LLC will have to pay $4.3 million, while Heller herself will have to pay $700,000.  USAO SDGA

Tagged in: Chiropractic, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

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