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June 26, 2015

Charlie Chi, the former president and CEO of OtisMed Corporation, was sentenced to two years in prison and to pay a $75,000 fine for intentionally distributing a medical device used in knee replacement surgery after its application for marketing clearance had been rejected by the Food and Drug Administration.  In September 2014, OtisMed, now a subsidiary of Stryker Corporation, was sentenced to a criminal fine of $34.4 million and ordered to pay $5.16 million in criminal forfeiture for this conduct.  In a related civil settlement, OtisMed agreed to pay approximately $41.2 million to resolve its civil liability for submitting false claims to the Medicare, TRICARE, Federal Employees Health Benefits and Medicaid programs.  DOJ

Tagged in: FCA Federal, FDA Fraud, Medical Devices and DME, Off-Label and Unapproved Use, Other Government Health Programs,

June 24, 2015

Juan Carlos Delgado and Nereyda Infante, husband and wife owners of an Orlando health care clinic pleaded guilty to engaging in a $2.5 million health care fraud scheme.  They owned and operated several health care clinics under variations of the name Prestige Medical and from February 2012 to September 2014 they fraudulently billed Medicare on behalf of the Prestige clinics for services that never were administered.  DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud,

June 18, 2015

Edward Berman, a physician with a practice in Ridgefield, Connecticut, agreed to pay $218,633 to resolve allegations he violated the False Claims Act by submitting claims to Medicare for skilled nursing facility services that were not performed in accordance with Medicare requirements.  Specifically, the government alleges that Berman “upcoded” certain services, submitting claims to Medicare by using a higher-paying billing code when services with lower-paying billing codes were actually provided.  DOJ

Tagged in: FCA Federal, Medical Billing Fraud, SNF, Upcoding,

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services.  According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level.  The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Upcoding,

June 16, 2015

Hebrew Homes Health Network Inc., a Florida-based operator of rehabilitation and skilled nursing facilities, along with its former president and executive director William Zubkoff, agreed to pay $17 million to resolve allegations it violated the False Claims Act by improperly paying doctors for referrals of Medicare patients requiring skilled nursing care.  It is the largest settlement involving alleged violations of the Anti-Kickback Statute by skilled nursing facilities in the US.  The allegations against Hebrew Homes first arose in a whistleblower lawsuit filed by Stephen Beaujon, a former CFO of Hebrew Homes, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $4.25 million.  Whistleblower Insider

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

June 16, 2015

Jacksonville, Florida-based home health company Advanced Homecare, Inc.agreed to pay $1,293,169 to settle charges it violated the False Claims Act by billing the government for millions of dollars of medically unnecessary services.  According to the government, Advanced Homecare accepted and treated patients who were not actually homebound and did not have a valid physician certification of home health need, as required by Medicare.  The allegations first arose in a whistleblower lawsuit filed by Advanced Homecare former employee Marsha Yandell under the qui tam provisions of the False Claims Act.  Ms. Yandell will receive a whistleblower award of more than $200,000.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

June 15, 2015

Children’s Hospital, Children’s National Medical Center Inc. and its affiliated entities agreed to pay $12.9 million to resolve allegations they violated the False Claims Act by submitting false cost reports and other applications to the components and contractors of the Department of Health and Human Services, as well as to Virginia and District of Columbia Medicaid programs.  The allegations first arose in a whistleblower lawsuit filed by former Children’s National Medical Center employee James A. Roark Sr. under the qui tam provisions of the False Claims Act.  Mr. Roark will receive a whistleblower award of $1,890,649.98.  DOJ

Tagged in: FCA Federal, FCA State, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

June 9, 2015

Earnest Gibson III, the former president of Riverside General Hospital, Earnest Gibson IV, the operator of Devotions Care Solutions, a Riverside satellite psychiatric facility, and Regina Askew, the owner of Safe and Sound group home, were sentenced to 45 years, 20 years and 12 years in prison, respectively, for their roles in a $158 million Medicare fraud scheme.  They were also ordered to pay restitution in the amount of $46,753,180, $7,518,480 and $46,255,893 respectively.  According to the evidence, the defendants had patients sit around the facility watching movies while they received no treatment, ultimately billing Medicare more than $158 million for care that was never provided.  DOJ

Tagged in: Hospital Fraud, Medical Billing Fraud,

June 5, 2015

Atlanta-based dental practice Dennis B. Jaffe D.M.D., P.C. and its principal Dennis Jaffe agreed to pay $324,327.05 to settle charges they violated the False Claims Act by fraudulently billing Medicaid for tooth extraction procedures and for fraudulently billing for services rendered by a dental assistant when Jaffe was not present in the office. According to the government, Jaffe fraudulently sought payment from Medicaid for higher and more expensive levels of service than were actually performed, a practice commonly referred to as “upcoding.”  The allegations first arose in a whistleblower lawsuit filed by Michelle Smith under the qui tam provisions of the False Claims Act.  DOJ

Tagged in: FCA Federal, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme.  Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit.  Clearview is now owned by Community Health Systems which purchased HMA in January 2014.  According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute.  As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act.  The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $119,031.  DOJ, GA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

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