Archive

August 24, 2015

The New York Attorney General announced a $6 million dollar settlement with Empire State Home Care Services, Inc. (Empire), a home care agency operating out of Brooklyn, NY. The settlement resolves claims that Empire improperly reported its home health aide hours as well as administrative and general expenses on cost reports filed between 2002 and 2005. These cost reports were used to set the reimbursement rates that Empire received from the state for the years 2004 through 2007 and resulted in over $3 million in reimbursements to which Empire was not entitled. NY

August 24, 2015

The New York Attorney General announced settlement agreements with five defendants in a False Claims Act case that will return more than $8 million to the Medicaid and Medicare programs. The agreements resolve claims that SpecialCare Hospital Management Corporation defrauded Medicaid and Medicare by illegally referring patients to unlicensed drug and alcohol treatment programs in exchange for kickbacks. Investigation of the defendants began after whistleblowers Mathew I. Gelfand, M.D. and Enrico Montaperto filed complaints under New York’s False Claims Act. NY

August 18, 2015

Pharmaceutical companies Concordia Pharmaceuticals Inc. and Par Pharmaceutical, Inc. have settled FTC charges that they entered into an unlawful agreement not to compete in the sale of generic versions of Kapvay, a prescription drug used to treat Attention Deficit Hyperactivity Disorder. As part of the settlement, the companies agreed not to enforce the anticompetitive provisions of their agreement, in which Concordia agreed not to sell an authorized generic version of Kapvay in exchange for a share of Par’s revenues. FTC

August 4, 2015

Pediatric Services of America, Inc., reached a $2.7 million federal-state settlement resolving allegations that the company inappropriately failed to return overpayments received from state Medicaid programs as well as other federally insured health programs. PSA is also alleged to have overcharged for home nursing services by improperly rounding-up claims to the nearest whole hour. Connecticut Department of Social Service Commissioner Roderick L. Bremby said, “This settlement exemplifies the outstanding work across the state and federal governments to obtain compensation for the taxpayer-funded Medicaid program when medical providers cross the line.” CT

July 29, 2015

New York Attorney General Eric T. Schneiderman announced the sentencing of the executive director of a company for stealing funds from the Nursing Home Transition and Diversion program, a Medicaid-funded program that provides senior citizens and those suffering from physical disabilities an alternative to institutional living through the use of Medicaid funds for renovations to the homes of the elderly and disabled (wheelchair ramps, grab bars, etc.). Defendant plead guilty to grand larceny, based on the submission of bids and cost reports, which falsely stated the actual costs of the projects, significantly inflating the actual costs or including services which were never provided. NY

July 27, 2015

A group of scammers who falsely promised consumers new Medicare cards in order to obtain their bank account numbers and debit their accounts will be banned from selling healthcare-related products and services under FTC settlements. The settlements resolve charges the FTC filed last year against Benjamin Todd Workman and Glenn Erikson and their companies. Their telemarketers falsely told consumers they needed their bank account numbers to verify their identities before sending a new Medicare card, promising they would not take money from the accounts. In fact, they took several hundred dollars from each consumer’s account and provided nothing in return. In some cases, their telemarketers falsely promised to provide consumers with identity theft protection services. FTC

July 20, 2015

Following a jury trial, Humphrey Udeh was convicted of defrauding New York’s Medicaid program of over $1 million. Udeh billed the state for over three thousand units of a highly-specialized and expensive liquid pediatric nutritional formula, when he actually dispensed over-the-counter nutritional supplement formulas. In order to perpetuate the scam, Udeh utilized generic prescriptions of pediatric formula and false letters of medical necessity, obtained by employees of his company, Advanced Medical Supply, from unsuspecting physician and medical facilities. He then used the generic prescriptions and false letters to support his fraudulent claims. Udeh was sentenced to serve 7 to 21 years in state prison and pay a $1.7 million fine. NY

July 15, 2015

A Hawaii administrative panel determined that Liberty Dialysis was overpaid over $7 million for treatments given to Medicaid patients between 2006 and 2010. While the Attorney General stated that the original overpayments were the result of a state computer error, Hawaii also announced that it was pursuing litigation against Liberty, which is alleged to have known it was being overpaid and continued to submit claims in a way designed to continue those overpayments. HI

July 10, 2015

New York reached a $22.4 million settlement with the pharmacy Trinity Homecare LLC, primarily owned by Walgreen Co. The settlement relates to Synagis, an injectable drug for premature infants at risk for Respiratory Syncytial Virus (“RSV”). The drug can cost more than $2,000 per dose. Trinity had its staff try to sell Synagis by directly contacting the families of outpatient premature babies or their doctors, regardless of a patient’s need or if the baby’s current physician wanted it prescribed. According to allegations, initially lodged by a whistleblower hospital physician, Trinity staff improperly obtained babies’ names and other patient information from the hospital’s neo-natal intensive care unit logbooks. The whistleblower also alleged that Trinity misappropriated her name and medical license number on one alleged Synagis prescription for a baby she had never cared for. The Attorney General also conducted an audit and found that Trinity billed Medicaid when the pharmacy had no written prescription or when a purported prescription was invalid, including because it lacked a prescriber’s signature, patient’s name or a date. NY

July 6, 2015

New York announced a $400,000 settlement with a transportation company that was unable to provide documentation for services it had billed to Medicaid. “Providers must be able to properly document services for which they received payment from Medicaid,” said Attorney General Schneiderman. “Doing otherwise drains Medicaid of precious resources, and my office will steadfastly guard New York taxpayer dollars expended to ensure quality care to those most in need.” NY