Archive

February 25, 2015

New York Attorney General Eric T. Schneiderman announced a settlement with nonprofit Regional Aid for Interim Needs, Inc. (RAIN) for diverting $800,000 in Medicaid funds to make mortgage payments on the agency’s administrative headquarters in violation of the organization’s funding agreements with the NYC Human Resource Administration. Under the settlement, RAIN, which provides home attendant services to elderly residents in the Bronx, must repay the illegally diverted $800,000 back to the Medicaid program. NY

February 23, 2015

The FTC has challenged marketers of “melanoma detection” apps, MelApp and Mole Detective, for deceptively claiming their mobile apps could detect symptoms of melanoma, even in its early stages, without scientific evidence to back up its claims. FTC

February 6, 2015

Minnesota-based medical device manufacturer Medtronic Inc. agreed to pay $2.8M to resolve allegations it violated the False Claims Act by causing physicians to submit false claims to federal health care programs for investigational medical procedures known as “SubQ stimulations” that were not reimbursable. According to the government, Medtronic improperly promoted the procedure and the use of its spinal cord stimulation devices for the procedure even though its safety and efficacy had not been established by the FDA. The charges were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Medtronic sales representative Jason Nickell. He will receive a whistleblower award of $602,000. DOJ

February 4, 2015

Pennsylvania Attorney General Kathleen G. Kane and the Office of Inspector General of the U.S. Department of Health & Human Services announced Medicaid fraud and other charges against Philadelphia-based Infinite Care Inc., sister company Infinite Care Special Needs Inc., and the companies’ vice president and treasurer. According to the Grand Jury, Infinite Care fraudulently billed Medicaid by more than $1M for services not rendered from January 2010 to the present, and after the company received a Grand Jury subpoena, it held a meeting where the decision was made to destroy the fraudulent paperwork submitted to the Commonwealth for services not provided and for inflated services. PA

January 30, 2015

Massachusetts Attorney General Maura Healey announced Neighborhood Diabetes, Inc. will pay more than $1.5M to settle allegations it improperly billed and received payments from the state’s Medicaid program when it automatically refilled prescription medications that were not specifically requested by MassHealth patients or caregivers. The settlement is the second case in the Commonwealth to address a pharmacy’s operation of an improper automatic refill program with MassHealth members. In September 2013, AllCare Pharmacy agreed to pay $1.6M to settle similar allegations. MA

January 22, 2015

Pennsylvania Attorney General Kathleen G. Kane announced the arrest of Claire Risoldi of Bucks County and four members of her family who allegedly conspired to defraud insurance companies in excess of $20M to live an “excessively extravagant lifestyle.” PA

January 20, 2015

Massachusetts Attorney General Martha Coakley announced South Shore Physician Hospital Organization will pay $1.77M to settle allegations of operating a recruitment grant program through which it paid kickbacks to its physician members in exchange for patient referrals. MA

January 20, 2015

Florida Attorney General Pam Bondi’s Medicaid Fraud Control Unit arrested six former Targeted Case Managers of DS Connections, Inc. for more than $170,000 in Medicaid fraud. FL

January 16, 2015

Washington Attorney General Bob Ferguson announced Sea Mar Community Health Centers agreed to pay $3.35M to settle charges of improperly billing Medicaid for thousands of dental appointments. According to the government, Sea Mar billed fluoride treatments as stand-alone appointments with a dentist or hygienist when they could have been performed much more cheaply by dental assistants as part of a patient’s regular six-month checkups. WA

January 12, 2015

New York Attorney General Eric T. Schneiderman announced an agreement with Excellus Health Plan, Inc. requiring that its contracted health care providers issue refunds to thousands of members in New York State for charging excessive copays. The investigation began when an Excellus member complained to the Attorney General’s Health Care Bureau Helpline that his provider billed him a specialty care co-payment of $25 after visiting his primary care physician to whom he had already paid the primary care co-payment of $15. NY