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Page 140 of 158

January 29, 2015

Four South Florida residents were sentenced in connection with a long-running $6.2M Medicare fraud scheme involving Professional Medical Home Health LLC, a Miami home health care agency operated for the purpose of billing the Medicare program for expensive physical therapy and home health services that were not medically necessary or actually provided. Dennis Hernandez was sentenced to 120 months in prison and to pay $1,438,186; Jose Alvarez was sentenced to 120 months in prison and to pay $2,972,570; Joel San Pedro was sentenced to 97 months in prison and to pay $4,938,432; Alina Hernandez was sentenced to 24 months in prison and to pay $204,526.05. DOJ

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

January 26, 2015

Ramon Regueira, the owner and operator of a Miami home health care agency Nation’s Best Care Home Health Corp. was sentenced to 106 months in prison and to pay $21M for his participation in a $30M Medicare fraud scheme. Regueira admitted he and his co-conspirators operated Nation’s Best for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary or not provided. He further admitted he and his co-conspirators paid kickbacks and bribes to patient recruiters who provided patients to Nation’s Best, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.DOJ

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

January 26, 2015

Kentucky-based ambulance services company Lafferty Enterprises, LLC(d/b/a Trans-Star Ambulance Services) agreed to pay $948,000 to settle charges it violated the False Claims Act by billing federal health care programs for medically unnecessary services over the course of several years. According to the government, from February 2006 until December 2012, the company transported Medicare patients to and from dialysis clinics by ambulance when an ambulance transport was not medically necessary. The charges originated from a whistleblower lawsuit filed by Kevin Fairlie under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $189,600. DOJ

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

January 16, 2015

A federal court in California issued an injunction shutting down Health One Pharmaceuticals Inc., a manufacturer of dietary supplements and unapproved new drugs. The firm and its president, Richard S. Yeh, agreed to shut down and resolve the lawsuit as part of a consent decree. The government alleged, among other things, the defendants failed to meet current good manufacturing practices for dietary supplements by failing to conduct appropriate testing and misbranding the supplements because their labels did not include all the information required by federal law. DOJ

Tagged in: CGMP Violation, Off-Label and Unapproved Use, Pharma Fraud,

January 14, 2015

Michigan physician Paula Williamson was sentenced to 15 months in prison and to pay more than $1M in restitution for her role in a $2.1M home health care fraud scheme involving Michigan-based home health care agency AMB Healthcare Inc. According to her plea agreement, Williamson conspired with others to commit health care fraud by referring Medicare beneficiaries for home health care services that were medically unnecessary and never provided. She also falsified documents used to support the false Medicare claims. DOJ

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

January 9, 2015

Felix Gonzalez, owner of Miami-based home health care company AA Advanced Care Inc. pleaded guilty in connection with a $32 million Medicare fraud scheme. Specifically, Gonzalez admitted he and his co-conspirators operated AA Advanced for the purpose of billing Medicare for, among other things, expensive physical therapy and home health care services not medically necessary or not provided at all. He also admitted he paid kickbacks and bribes to patient recruiters in exchange for patient referrals, prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services. DOJ

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

January 9, 2015

Global pharmaceutical company Daiichi Sankyo Inc. agreed to pay $39 million to resolve allegations it violated the False Claims Act by paying kickbacks to induce physicians to prescribe Daiichi drugs, including Azor, Benicar, Tribenzor and Welchol. According to the government, Daiichi paid physicians improper kickbacks in the form of speaker fees as part of Daiichi’s Physician Organization and Discussion programs which were often just lavish dinners with the speaking physicians’ own medical group or staff. The charges originated with a whistleblower lawsuit filed by former Daiichi sales representative Kathy Fragoules under the whistleblower provisions of the False Claims Act. She will receive a whistleblower award of $6.1 million. DOJ

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

December 18, 2014

Former Department of Defense civilian employee Jonathan M. Hargett was sentenced today to serve 40 months in prison and to pay $2.2M in restitution for his participation in a health care fraud scheme in which he collected over $2.2M from fraudulent claims for federal health care benefits. DOJ

Tagged in: Healthcare Fraud,

December 17, 2014

Mark Morad and Dr. Divini Luccioni, both of Louisiana, pleaded guilty to their role in a $56M Medicare fraud scheme. According to court documents, Morad directed the scheme through multiple New Orleans-area companies he owned, including Interlink Health Care Services Inc.,Memorial Home Health Inc., Lakeland Health Care Services Inc., Lexmark Health Care LLC, and Med Rite Pharmacy Inc. Morad paid kickbacks to recruiters who canvassed New Orleans neighborhoods for Medicare beneficiary numbers, which Morad then used to bill Medicare for services that were not medically necessary or not provided. Dr. Luccioni admitted that he signed home health referrals and wrote DME prescriptions that were used to support these fraudulent billings. DOJ

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

December 8, 2014

Medical products manufacturer OtisMed Corp and its former CEO Charlie Chi admitted to intentionally distributing knee replacement surgery cutting guides (called the OtisKnee) after the Food and Drug Administration (FDA) had rejected their application for marketing clearance. OtisMed agreed to pay more than $80M to resolve its related criminal and civil liability for distributing an adulterated medical device in violation of the Food, Drug, and Cosmetic Act (FDCA), and submitting fraudulent claims in violation of the False Claims Act. Whistleblower Insider

Tagged in: FCA Federal, Medical Devices and DME, Off-Label and Unapproved Use,

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