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April 12, 2022

Physician Partners of America LLC (PPOA), its founder Rodolfo Gari, and its former chief medical officer Dr. Abraham Rivera, have agreed to pay $24.5 million to settle allegations of violating the Stark Law, False Claims Act, and Financial Institutions Reform, Recovery and Enforcement Act (FIRREA).  The settlement resolved claims by whistleblowers Donald Haight, Dawn Baker, Dr. Harold Cho, Dr. Venus Dookwah-Roberts, and Dr. Michael Lupi, all currently or formerly employed with PPOA.  According to the whistleblowers and the government, PPOA allegedly billed Medicare and Medicaid for medically unnecessary testing, paid illegal kickbacks to its physician employees, and made false statements on a loan from the Paycheck Protection Program.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Programs Fraud, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Whistleblower Case,

April 6, 2022

Florida hospital chain BayCare Health System Inc. will pay $20 million to resolve claims that the company knowingly caused false claims for federal Medicaid matching funds to be submitted to the United States by making improper, non-bona fide cash donations to the Juvenile Welfare Board of Pinellas County (JWB) knowing that the funds would be transferred by JWB to the State of Florida’s Agency for Health Care Administration for Florida’s Medicaid Program, which would trigger a corresponding federal matching payment.  The prohibition on non-bona fide donations ensures that states are paying a share of Medicaid payments; the non-bona fide donations increased Medicaid payments received by BayCare without any actual expenditure of state or local funds and enabled BayCare to recoup its original donations to JWB and also receive federal matching funds. The case was initiated with a qui tam complaint filed by Larry Bomar, who will receive $5 million as an award for initiating the whistleblower action. DOJ; MD FL

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

March 30, 2022

Multiple sales representatives of Delaware-based pharmacy, Heritage Therapeutics, LLC have been ordered to forfeit and/or pay fines totaling over $8.7 million after they were found to have paid kickbacks to physicians in exchange for prescribing expensive compounded medications to TRICARE beneficiaries.  Additionally, Heritage and various executives have entered into a settlement agreement to resolve claims under the Anti-Kickback Statute and False Claims Act.  USAO EDPA

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Other Government Health Programs,

March 28, 2022

A Pennsylvania-based psychiatrist and his wife have agreed to pay $3 million in the largest recovery against a single psychiatrist ever in the history of the U.S. Department of Labor – Office of Worker’s Compensation Programs (OWCP).  From 2013 to 2021, Dr. Harry Doyle and his wife and sole employee, Sonya, allegedly billed OWCP for services that weren’t rendered, submitted double-billed and upcoded patient claims, and falsified patient records to reflect their false billing.  As part of the settlement, they will be excluded from participating in federal healthcare programs for 25 years.  USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Upcoding,

March 25, 2022

A Department of Energy contractor that applied for and received a $1.3 million Paycheck Protection Program loan has, together with its owners, agreed to pay nearly $3 million in restitution and penalties to resolve their liability under the False Claims Act.  HPM Corporation and owners Holly and Grover Cleveland Mooers admitted that they submitted materially false statements to the Small Business Administration in order to obtain the loan and induce a forgiveness of the loan.  However, instead of using the funds on payroll, as they had represented, they transferred the entire amount to their personal account.  USAO EDWA

Tagged in: FCA Federal, Government Procurement Fraud, Government Programs Fraud,

March 25, 2022

Two New York-based home health agencies, All American Homecare Agency and Crown of Life Care NY LLC, have agreed to pay a total of $5.4 million to settle allegations of violating federal and state False Claims Acts.  The agencies had allegedly paid their home health aides below minimum wage, despite claiming otherwise and receiving millions for said wages from Medicaid.  In addition to the monetary penalties, the agencies will also pay back wages owed to current and former aides.  NY AG; USAO EDNY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice,

March 22, 2022

Ten doctors in Texas and a healthcare executive have agreed to pay nearly $1.7 million to resolve allegations of violating the False Claims Act, Anti-Kickback Statute, and Stark Law.  In exchange for ordering laboratory tests from Rockdale Hospital d/b/a A little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation, the doctors allegedly received thousands of dollars in kickbacks disguised as investment returns.  USAO EDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

March 17, 2022

Reveal Global Consulting, LLC has agreed to pay $820,000 to resolve allegations of improperly billing the Defense Intelligence Agency.  Per contract terms, Reveal was only supposed to bill for time and materials expended to fulfill contractual obligations; however, the firm allegedly continued to bill the standard amount even for months when fewer than promised employees were devoted to the contract.  Additionally, Reveal allegedly submitted bills with inflated and misstated work by subcontractors, and bills for work by employees who had already left the company.  USAO EDPA

Tagged in: Contract Non-Compliance, Defense Contract Fraud, FCA Federal,

March 14, 2022

Freight carriers YRC Freight Inc., Roadway Express Inc., and Yellow Transportation Inc. will pay $6.85 million to resolve government claims that they knowingly overcharged the Department of Defense on military freight shipments.  Whistleblower James Hannum, a Yellow Transportation employee, filed a qui tam action alleging that the companies had a practice of re-weighing shipments and, when the reweighs showed an increase from the original weight, defendants charged DOD for these higher weights, but when the reweighs showed a decrease from the original weight, defendants allegedly concealed the lower weight and instead charged DOD for the original, inflated weights.  Hannum will receive a whistleblower award of approximately $1.3 million.  DOJ

Tagged in: Defense Contract Fraud, Falsifying Invoices, FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

March 8, 2022

Comprehensive Health Services LLC (CHS), a Florida-based contractor that provides medical services at government facilities in Iraq and Afghanistan, has agreed to pay $930,000 to resolve claims under the False Claims Act.  According to two separate qui tam cases filed in the Eastern District of New York, CHS falsely certified to the State Department and Air Force that it had complied with contractual cybersecurity requirements when, in fact, it had failed to to properly store patient medical records on a secure electronic medical record system, and had falsely represented that it used approved medical supplies when, in fact, it had relied on unapproved controlled substances from foreign sources.  DOJ; USAO EDNY; USAO MDFL

Tagged in: Certifications, Contract Non-Compliance, Cybersecurity and Data Breaches, FCA Federal, Government Procurement Fraud,

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