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April 21, 2015

Texas-based Citizens Medical Center agreed to pay $21,750,000 to settle allegations it violated the False Claims Act and Stark Statute by engaging in improper financial relationships with referring physicians.  According to the government, the hospital provided compensation to several cardiologists that exceeded the fair market value of their services and paid bonuses to emergency room physicians that improperly took into account the value of their cardiology referrals.  The allegations first arose in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dakshesh “Kumar” Parikh, Harish Chandna and Ajay Gaalla.  They will collectively receive a whistleblower award of $5,981,250.  DOJ

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

April 16, 2015

Felix Gonzalez, owner of Miami home health care company AA Advanced Care Inc. was ordered to pay $21,423,160 in restitution and sentenced to 113 months in prison in connection with a $32 million Medicare fraud scheme.  Gonzalez admitted operating his company for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were not medically necessary or provided at all.  He further admitted he negotiated and paid kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

April 15, 2015

Rahmat Begum, owner of Detroit-area home health care agency Empirical Home Health Care Inc. pleaded guilty to fraud and money laundering charges in connection with her role in a $2.6 million home health care scheme.  According to her guilty plea, Begum conspired to submit falsified claims to Medicare based upon referrals obtained through illegal kickbacks to patient recruiters and physicians.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

April 15, 2015

Mehran Zamani pleaded guilty to a multimillion Medicaid fraud scheme relating to his work for Landmark Dental, Dental Group of Stamford and Dental Group of Connecticut where he served as the front for Gary Anusavice, the real owner of the businesses, who was a convicted felon, former dentist, and excluded Medicaid provider.  FBI

Tagged in: Healthcare Fraud, Medicaid,

April 9, 2015

Virginia-based cardiovascular testing disease laboratory Health Diagnostics Laboratory Inc. agreed to pay $47 million to resolve allegations it violated the False Claims Act by paying kickbacks to physicians in exchange for patient referrals and billing federal health care programs for medically unnecessary testing.  A second cardio testing lab, California-based Singulex Inc., agreed to pay $1.5 million to settle similar charges.  The allegations first arose in a whistleblower lawsuit filed by Dr. Michael Mayes, Scarlett Lutz, Kayla Webster and Chris Reidel under the qui tam provisions of the False Claims Act.  The whistleblower award they will receive has yet to be determined.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

March 31, 2015

Ohio-based Robinson Health System Inc. agreed to pay $10 million to settle claims it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute by engaging in improper financial relationships with referring physicians.  DOJ

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

March 23, 2015

Michigan-based Portage Hospital, LLC agreed to pay $4,446,392 to settle allegations its hospital-owned home health care agency, Portage Health Home Care & Hospice, violated the False Claims Act by submitting false claims to Medicare for unnecessary or unwarranted physical therapy services.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Hospital Fraud, Lack of Medical Necessity,

March 20, 2015

A federal jury in Los Angeles convicted Hakop Gambaryan, owner of Colonial Medical Supply, of four counts of health care fraud in connection with a $3.3 million Medicare fraud scheme.  According to evidence presented at trial, Gambaryan paid cash kickbacks to medical clinics for fraudulent prescriptions for durable medical equipment, such as expensive power wheelchairs, which the patients did not need, and then used these fraudulent prescriptions to bill Medicare.  DOJ

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

March 20, 2015

A federal jury in Los Angeles convicted Sylvia Walter-Eze, former owner ofEzcor Medical Supply, in connection with a $3.5 million Medicare and Medi-Cal fraud scheme.  The evidence at trial demonstrated that Walter-Eze paid illegal kickbacks to patient recruiters in exchange for patient referrals, and to physicians for fraudulent prescriptions for power wheelchairs and other medically unnecessary equipment.  DOJ

Tagged in: Healthcare Fraud, Medical Devices and DME,

March 19, 2014

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $5,412,502 to resolve claims it violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons.  The allegations arose in a whistleblower lawsuit filed by Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A., under the qui tam provisions of the False Claims Act.  Dr. Montejo will receive a whistleblower award of $1,082,500.  DOJ

Tagged in: Other Government Health Programs,

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