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Page 135 of 158

May 13, 2015

Olufunke Ibiyemi Fadojutimi, a registered nurse and former owner of Lutemi Medical Supply, was sentenced to four years in prison and ordered to pay restitution in the amount of $4,372,466 for her role in an $8.3 million Medicare fraud scheme.  The evidence at trial showed that Fadojutimi and her co-conspirators paid cash kickbacks to patient recruiters in exchange for patient referrals, and additional kickbacks to physicians for fraudulent prescriptions for medically unnecessary durable medical equipment, such as power wheelchairs.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME,

May 12, 2015

Alexander Lara,  an owner of Miami home health care company Longcare Home Health Corporation was sentenced to 10 years in prison and ordered to pay $13,771,528.94 in restitution and to forfeit $13,771,528.94 for his leading role in a $13 million Medicare fraud scheme that involved paying kickbacks and bribes to patient recruiters, Medicare beneficiaries and others in South Florida doctors’ offices and medical clinics.  Lara admitted his company fraudulently billed the Medicare program for expensive physical therapy and home health care services that were not medically necessary or not provided at all.  DOJ

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

May 7, 2015

Health Management Associates Inc. (and 14 hospitals it previously owned), along with Community Health Systems and North Texas Medical Center, agreed to collectively pay $15.69 million to settle whistleblower charges they violated the False Claims Act by seeking and receiving Medicare reimbursement for Intensive Outpatient Psychotherapy (IOP) services that were not medically reasonable or necessary.  The IOP services in question were typically performed on the providers’ behalf by Louisiana-based Allegiance Health Management.  The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The unidentified whistleblower will receive a whistleblower award of $2,667,300.  Whistleblower Insider

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

May 7, 2015

Tennessee-based Jackson-Madison County General Hospital agreed to pay $1,328,465 to resolve allegations it improperly billed Medicare and Medicaid for the placement of unnecessary cardiac stents and other unnecessary cardiac procedures including angioplasty, catheterization, and ultrasound imaging.  The allegations were first raised in a whistleblower lawsuit filed by Dr. Wood D. Deming under the qui tam provisions of the False Claims Act.  Mr. Deming will receive an undisclosed portion of the settlement as a whistleblower award.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

May 1, 2015

Accredo Health Group, a unit of Express Scripts Holding Co., agreed to pay $60 million to settle False Claims Act and Anti-Kickback Statute charges that the company participated in a kickback scheme with Novartis Pharmaceuticals Corp. involving the prescription drug Exjade.  According to the government, Novartis provided kickbacks, in the form of patient referrals and related benefits, to Accredo in exchange for Accredo recommending refills to Exjade patients.  The government also intervened in a whistleblower lawsuit against Novartis for the same alleged scheme.  The government claims defendants allegedly understated the serious and potentially life-threatening side effects of Exjade when promoting the drug’s benefits to patients. FBI

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

April 30, 2015

Miami-area doctor Barry Kaplowitz was sentenced to 60 months in prison and ordered to pay more than $2.9 million in restitution for his role in a $5.5 million Medicare fraud scheme involving fraudulent billings by Hollywood Pavilion, a psychiatric hospital in Hollywood, Florida.  According to evidence, Kaplowitz signed fraudulent medical records in order to make it appear that the hospital’s patients qualified for and received intensive outpatient services, even though they did not.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

April 29, 2015

The Hospital Authority of Irwin County (ICH) and several doctors agreed to pay $520,000 to settle charges they violated the False Claims Act, the Anti-Kickback Statute, the Stark Law and related Georgia Medicaid policies in connection with the amount of compensation paid by ICH to one of the doctors, ICH’s leases with the doctors, and the supervision of certain diagnostic imaging services at ICH.  The allegations first arose in a whistleblower lawsuit filed by Connie Brogdon and Summer Holland under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act.  They will receive an undisclosed portion of the settlement payment.  DOJ

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

April 27, 2015

The Medical Center of Central Georgia agreed to pay $20 million to settle allegations it violated the False Claims Act by billing Medicare for more expensive inpatient services that should have been billed as less costly outpatient or observation services.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Upcoding,

April 23, 2015

Louisiana doctor Winston Murray pleaded guilty to federal health care fraud charges, admitting (i) he wrote home health care referrals for Medicare beneficiaries he knew were not confined to their homes, and (ii) his referrals were used by home health companies Interlink Health Care Services Inc. and Lakeland Health Care Services Inc., among others, to fraudulently bill Medicare for home health services not medically needed or not provided.  From 2007 through 2014, these companies and other companies involved in this scheme submitted more than $56 million in claims to Medicare, a vast majority of which were fraudulent.  DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

April 21, 2015

Family Dermatology P.C., which owns and operates a dermatopathology lab in Georgia and several dermatology practices throughout the Eastern United States, agreed to pay $3,247,835 to settle allegations it violated the False Claims Act and the Stark Statute by engaging in improper financial relationships with a number of its employed physicians.  According to the government, Family Dermatology routinely required its dermatologists to use Family Dermatology’s in-house pathology lab, which operated under the name Nelson Dermatopathology, for their pathology services.  The allegations first arose in three whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Scott M. Ross MD, Mark F. Baucom and Harold Milstein MD.  They will collectively receive a whistleblower award of more than $584,000.  DOJ

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

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