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June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services.  Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing.  The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC.  The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be determined whistleblower award. DOJ

Tagged in: FCA Federal, FCA State, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 28, 2015

Garden State Cardiovascular Specialists P.C., a New Jersey-based cardiology practice which owns and operates several facilities in New Jersey under the name NJ MedCare/NJ Heart, agreed to pay more than $3.6 million to resolve allegations the company and its principals, Dr. Jasjit Walia and Dr. Preet Randhawa, submitted claims to Medicare for various cardiology diagnostic tests and procedures, including stress tests, cardiac catheterizations and external counterpulsation, which were not medically necessary. The allegations were first raised in a whistleblower lawsuit filed by Cheryl Mazurek under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of more than $648,000.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 27, 2015

Durable medical equipment suppliers Orbit Medical Inc. and its partial successor, Rehab Medical Inc., agreed to pay $7.5 million to settle False Claims Act charges that Orbit submitted false claims to federal health care programs for power wheelchairs and accessories.  According to the government, Orbit sales representatives knowingly altered physician prescriptions and supporting documentation to get Orbit’s power wheelchair and accessory claims paid by Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency.  The allegations were first raised in a whistleblower lawsuit filed by former Orbit employees Dustin Clyde and Tyler Jackson under the qui tam provisions of the False Claims Act.  They collectively will receive a whistleblower award of approximately $1.5 million.  Whistleblower Insider

Tagged in: FCA Federal, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

May 22, 2015

Detroit-area neurosurgeon Aria O. Sabit, owner and operator of the Michigan Brain and Spine Physicians Group, pleaded guilty to causing serious bodily injury to his patients in an $11 million Medicare fraud scheme.  According to court documents, Sabit admitted he derived significant profits by convincing patients to undergo spinal fusion surgeries with instrumentation (meaning specific medical devices designed to stabilize and strengthen the spine) which he never rendered.  DOJ

Tagged in: Healthcare Fraud,

May 21, 2015

Mohammad Khan, the former assistant administrator of Riverside General Hospital, was sentenced to 40 years in prison and to pay restitution in the amount of $31,321,200 for his role in a $116 million Medicare fraud scheme.  He previously pled guilty to his role in the scheme.  According to admissions made in connection with his guilty plea, from January 2008 through February 2012, Khan and others at Riverside General Hospital operated a scheme to defraud Medicare by submitting claims for partial hospitalization program (PHP) services that were not medically necessary and, in some cases, never provided.  Khan also admitted he and his co-conspirators paid kickbacks to patient recruiters and to owners and operators of group care homes in exchange for which those individuals delivered ineligible Medicare beneficiaries to the hospital’s PHPs.  To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme.  DOJ

Tagged in: Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

May 20, 2015

Pharmacy benefits manager Medco Health Solutions Inc., a wholly-owned subsidiary of the pharmacy benefit manager Express Scripts Holding Company, agreed to pay $7.9 million to settle allegations it engaged in a kickback scheme in violation of the False Claims Act.  According to the government, Medco solicited remuneration from AstraZeneca in exchange for identifying Nexium as the “sole and exclusive” proton pump inhibitor on certain of Medco’s prescription drug lists known as formularies.  AstraZeneca allegedly compensated Medco in the form of reduced prices on the following AstraZeneca drugs: Prilosec, Toprol XL and Plendil.  In January 2015, the government reached a $7.9 million settlement with AstraZeneca to resolve kickback allegations arising out of the same conduct.  The allegations first arose in a whistleblower lawsuit filed by former AstraZeneca employees Paul DiMattia and F. Folger Tuggle under the qui tam provisions of the False Claims Act.  They will receive a whistleblower reward from the recovery that has yet to be determined.  DOJ

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

May 20, 2015

Florida-based neurologist Dr. Sean Orr agreed to pay $150,000 to settle allegations he violated the False Claims Act by providing medically unnecessary services and drugs to federal health care program beneficiaries.  According to the government, from September 2009 to April 2012 Orr knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal health care programs to be billed for medically unnecessary services and drugs.  In 2014, the government settled related allegations against Baptist Health System Inc. – Orr’s former employer and the parent company for Baptist Neurology Inc. and Baptist Medical Center-Jacksonville – for $2.5 million.  The allegations first arose in a whistleblower lawsuit filed by former Baptist Neurology employee Verchetta Wells under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $26,250.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 18, 2015

A federal jury in Chicago convicted Rick E. Brown, the president of the in-home visiting physicians group Home Care America Inc., and Mary C. Talaga, the group’s biller, for their participation in a $4.5 million health care fraud scheme that included billing Medicare for services rendered to patients who were dead and services rendered by medical professionals who worked over 24 hours in a day.  DOJ

Tagged in: Healthcare Fraud,

May 14, 2015

Westchester County Health Care Corporation (d/b/a Westchester Medical Center) agreed to pay $18.8 million to settle charges it violated the False Claims Act, the Anti-Kickback Statute and the Stark Law.  According to the government, from approximately 2000 through 2007, WMC maintained a financial relationship with Cardiology Consultants of Westchester, P.C., a cardiology practice formerly operating on WMC’s Valhalla campus.  WMC allegedly advanced monies to CCW to open a practice for the express purpose of generating referrals to the hospital.  When CCW began making payments to WMC purportedly repaying the advances, WMC entered into retroactive, no-work consulting agreements under which it paid CCW tens of thousands of dollars.  WMC also allegedly allowed CCW to use WMC’s fellows in CCW’s private office free of charge, contrary to WMC’s historic practice.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud,

May 14, 2015

PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country, agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs.  The government’s allegations against PharMerica arose out of whistleblower lawsuit brought by Jennifer Denk, a pharmacist formerly employed by PharMerica, under the qui tam provisions of the False Claims Act.  Ms. Denk will receive a whistleblower award of $4.3 million.  Whistleblower Insider

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

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