Archive

January 12, 2022

A diabetic shoe company, Foot Care Store, Inc., d/b/a Dia-Foot, and its President and CEO, Robert Gaynor, have agreed to pay $5.5 million to resolve allegations of billing Medicare and Medicaid for custom diabetic shoe inserts when in fact, their inserts were made using generic foot models. The alleged misconduct occurred between 2013 and 2018 and was revealed in a whistleblower’s 2018 qui tam suit. In addition to the monetary penalty, Dia-Foot has entered into a three-year Integrity Agreement that requires the company to implement updated policies and procedures and submit to quarterly independent review of its claims to Medicare and Medicaid. USAO SDFL

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Whistleblower Case,

January 11, 2022

UC San Diego Health has agreed to pay $2.98 million to resolve allegations that it ordered and submitted referrals for medically unnecessary genetic testing, leading to the submission of false claims to Medicare. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare,

January 6, 2022

Centene Corporation will pay $21.15 million to resolve claims that the pharmacy benefit manager inaccurately reported its services and costs to New Hampshire’s Medicaid Care Management Program, resulting in overcharges to the state. NH (related settlements with Ohio, Mississippi, and Kansas)

Tagged in: Drug and DME Pricing, FCA State, Healthcare Fraud, Medicaid, Pharma Fraud,

January 5, 2022

Two Florida men, Reinier Gonzalez Caballero and Alexeis Napoles Manresa, have each been sentenced to a little over four years in prison for laundering the ill-gotten proceeds of a $3 million healthcare fraud scheme against Medicare. Over a couple months in 2019, durable medical equipment company Universal Ortho Supplies, Inc. billed Medicare for orthosis and prosthetics that were never prescribed by physicians, nor provided to patients. The reimbursements were then turned over to the defendants, who attempted to disguise the source of the funds by setting up shell corporations and opening up fake bank accounts. Two co-conspirators have already been convicted and sentenced; another two have pleaded guilty and await sentencing. USAO SDFL

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Devices and DME, Medicare, Money Laundering,

December 2, 2021

Texas-based Flower Mound Hospital Partners LLC has agreed to pay $18 million and enter into a five-year Corporate Integrity Agreement to resolve fraud allegations. According to Leslie Jennings, M.D., one of many physician-owners, when Flower Mound repurchased shares from physician-owners nearing retirement age and resold them to younger physicians, the company allegedly improperly took into account the value of each physician’s referrals in selecting to whom and how many shares would be resold. Claims arising from these referrals were then knowingly submitted to Medicare, Medicaid, and TRICARE, in violation of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act. For initiating a lawsuit that resulted in a successful enforcement action, Jennings will receive a $3 million share of the settlement. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

December 1, 2021

A collection of hospices known as Crossroads Hospice has agreed to pay $5.5 million to settle allegations raised in two qui tam suits by former employees Leanne Malone, Jackie Burns, and Angela Heck, and a home health physician in Tennessee, Dr. David Weber. In their lawsuits, the whistleblowers alleged that between 2012 and 2014, Crossroads billed Medicare for hospice care for patients who were not terminally ill, including patients with Alzheimer’s or dementia. Malone, Burns, and Heck will divide a million-dollar relator’s share. USAO WDTN

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, Whistleblower Case, Whistleblower Rewards,

November 9, 2021

Kaléo, Inc., a pharmaceutical manufacturer in Virginia, has agreed to pay $12.7 million to resolve a whistleblower’s allegations that it violated the Anti-Kickback Statute and False Claims Act in claims submitted to Medicare, TRICARE, and the Federal Employees Health Benefits Program. Between 2017 and 2020, kaléo allegedly provided kickbacks to physicians and their staff to induce and reward them for prescribing Evzio, a higher-priced version of a drug used to reverse opioid overdoses and which often requires prior authorization. Kaléo also allegedly directed pharmacies to submit false prior authorizations and dispense Evzio without collecting required co-pays. USAO MA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Pharma Fraud, Whistleblower Case,

November 5, 2021

Two men who pleaded guilty to causing $134 million in false claims to be submitted to Medicare and CHAMPVA have been sentenced to federal prison and ordered to pay restitution of over $29 million. Michael Nolan of Florida was sentenced to 6.5 years, while Richard Epstein of Colorado was sentenced to about 5 years. Using a telemarketing company called REMN Management LLC, as well as a telemedicine company called Comprehensive Telcare LLC, Nolan and Epstein had bribed physicians to sign medically unnecessary orders for durable medical equipment, which they then sold to co-conspirators as support for the false claims. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Other Government Health Programs,

November 1, 2021

Geisinger Community Health Services, based in Pennsylvania, has agreed to pay over $18.5 million to resolve its liability following a self-disclosure of violations of the False Claims Act. The violations occurred between 2012 and 2017 and involved physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients. USAO MDPA

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, Provider Fraud,

October 28, 2021

Rehab Authority, LLC, a physical therapy provider in Minnesota, has agreed to pay $4 million to resolve allegations by whistleblower Cami Lane that it violated the False Claims Act. RehabAuthority clinics had allegedly submitted false claims to Medicare, Medicaid, TRICARE, and the Veterans Health Administration for one-on-one outpatient physical therapy that was not provided. USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

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