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February 25, 2015

A federal jury in Detroit convicted Michigan patient recruiter Reginald Smith and Michigan physical therapist Rajan Patel for their roles in a $1.6M Medicare fraud scheme.  According to the evidence, Smith worked as a patient recruiter for Angle’s Touch Home Health Care LLC where he solicited patients for foot care services at adult foster care homes and then referred them to Angle’s Touch for medically unnecessary home health care services in exchange for kickbacks.  The kickbacks were disguised as payments to Smith’s nonprofit Medicare provider People Helping People of Detroit.  Patel worked as a physical therapist at Angle’s Touch where he fabricated patient medical records to make it appear that the recruited patients qualified for and received the home health care services, when they did not.  DOJ

Tagged in: Home Health and Hospice, Medical Billing Fraud,

February 24, 2015

Acadiana Cardiology LLC, Acadiana Cardiovascular Center and convicted doctor Mehmood Patel agreed to pay $650,000 to settle charges they violated the False Claims Act through unnecessary cardiovascular, endovascular and related procedures that Patel performed at Our Lady of Lourdes Hospital, Lafayette General Medical Center, Acadiana Cardiology and Acadiana Cardiovascular Center.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Christopher Mallavarapu, a cardiologist who formerly practiced with Patel.  DOJ

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

February 24, 2015

Louisiana oncologist Prabhjit S. Purewal agreed to pay $550,000 to settle allegations he defrauded Medicare, Tricare and Medicaid in violation of the False Claims Act by billing for chemotherapy drugs not approved by the FDA.  Dr. Purewal purchased the drugs from UK-based drug distributor Warwick Healthcare Solutions, Inc. (also known as Richard’s Pharma), which did not have a license to distribute drugs in the US.  DOJ

Tagged in: FCA Federal, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud, Provider Fraud,

February 24, 2015

Angel M. Mirabal, owner of Houston-based medical equipment supplier Quick Solutions Medical Supplies Inc., pleaded guilty to a $5M scheme to defraud Medicare.  Mirabel admitted he and his co-conspirators operated Quick Solutions for the purpose of billing Medicare for medical equipment not medically necessary or not provided.  DOJ

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

February 23, 2015

Two South Florida medical doctors and their wives, Dr. Alan and Lynn Buhler and Dr. Craig and Cynthia Prokos agreed to pay $1M and $90,000, respectively, to settle allegations they violated the False Claims Act when their wives accepted sham marketer salaries in exchange for their husbands’ referrals to a home health care company called A Plus Home Health Care Inc.  The US previously settled with A Plus and its owner Tracy Nemerofsky and five other couples that allegedly accepted payments from A Plus.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice,

February 18, 2015

Hospice services provider Compassionate Care Hospice Group agreed to pay $6.7M to settle charges it violated the federal and New York False Claims Acts by submitting claims to Medicare and Medicaid for hospice nursing services not actually or adequately provided.  Specifically, the government alleged CCH nurses routinely missed their required visits and then falsified nursing notes in patients’ files to make it appear as though the visits had been performed.  The charges originated in a whistleblower lawsuit filed by a former employee under the qui tam provisions of the False Claims Act.  Whistleblower Insider, NY

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

February 17, 2015

Alexander Lara, owner of Miami-based home health care company Longcare Home Health Corporation, pleaded guilty in connection with a $13M Medicare fraud scheme involving kickbacks and bribes to Medicare beneficiaries, doctors’ offices, medical clinics and others in exchange for patient referrals and fraudulent prescriptions to support fraudulent billings to Medicare.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

February 13, 2015

Illinois physician Dr. Michael J. Reinstein pleaded guilty to the crime of receiving illegal kickbacks and benefits totaling nearly $600,000 from pharmaceutical manufacturer Teva Pharmaceuticals USA Inc. and its subsidiary IVAX LLC in exchange for regularly prescribing the anti-psychotic drug clozapine to his patients.  Reinstein also agreed to pay $3.79M to settle a parallel civil lawsuit alleging he violated the False Claims Act for causing the submission of false claims to Medicare and Medicaid for the clozapine he prescribed for thousands of elderly and indigent patients in at least 30 Chicago-area nursing homes and other facilities.  In March 2014, Teva Pharmaceuticals and IVAX paid $27.6M million for their role in the kickback scheme. DOJ

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

February 11, 2015

Delaware-based pharmaceutical manufacturer AstraZeneca LP agreed to pay $7.9M to settle charges it violated the False Claims Act by engaging in an illegal kickback scheme with pharmacy benefit manager Medco Health Solutions.  The government alleged, among other things, that AstraZeneca agreed to provide remuneration to Medco in exchange for Medco maintaining for AstraZeneca’s Nexium drug “sole and exclusive” status on certain Medco formularies and through other marketing activities.  The charges originated with 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 collectively receive a whistleblower award of $1,422,000.  Whistleblower Insider

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

February 10, 2015

Iowa-based home healthcare company ResCare Iowa Inc. agreed to pay $5.63M to resolve allegations it violated the False Claims Act by submitting false home healthcare billings to the Medicare and Medicaid programs.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Medical Billing Fraud,

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