Archive

June 12, 2018

North Carolina announced the sentencing of Dr. Duke Ellington Ellis, who allegedly assisted Nature’s Reflections, a Durham-based behavioral health company, forge the signature of a licensed psychologist in order to submit millions of dollars in false claims to Medicaid. Ellis will face thirteen months in prison and will pay over a million dollars in restitution to the North Carolina Medicaid Program. NC

June 8, 2018

Skilled nursing facility company Signature HealthCARE, LLC will pay more than $30 million to the federal and Tennessee state governments to resolve False Claims Act allegations it placed patients in the highest therapy reimbursement level regardless of need; limited its therapy services to the minimum number of minutes required to bill at a given reimbursement level and discouraged the provision of care beyond that minimum; and pressured therapists to complete therapy even when patients were too ill or declined to participate. The suit was brought by two former employees and whistleblowers, who will receive a portion of the recovery. DOJ

May 29, 2018

Wal-Mart and Sam’s Club will collectively pay $825,000 to resolve federal and state False Claims Act allegations the company’s automatic prescription refills for Minnesota Medicaid patients violated Minnesota law and wasted taxpayer dollars on unnecessary and unused medications. USAO DMN

May 17, 2018

Hartford, Connecticut-based Community Renewal Team, an action agency that received federal and state grant funding, agreed to settle allegations under the Federal and Connecticut False Claims Acts that it charged employee hours spent on state-funded grant programs to federal grants from HHS, HUD, and DOE, charged an employee’s time to a Head Start grant when that employee was working on other programs, and failed to stop a program manager from misappropriating $18,500 for her person use; the agency will pay $362,000 to settle all claims. USAO DCT

January 22, 2018

Maryland announced it has joined the United States, the District of Columbia, and 19 other states in a settlement agreement relating to allegations against Benevis, LLC (formerly known as NCDR, LLC) and 133 Kool Smiles clinics that received non-clinical practice support from Benevis, LLC. Maryland will receive $1.022 million as a result of the settlement. The settlement will resolve allegations that Benevis/Kool Smiles knowingly submitted or caused to be submitted false claims to the Medicaid program related to dental services provided to pediatric patients. Under the settlement, Benevis/Kool Smiles agreed to pay $23.9 million collectively to the federal and state governments. The participating states will share $9.65 million of the total settlement. MD

January 10, 2018

Dental management company Benevis LLC (formerly known as NCDR LLC), and more than 130 of its affiliated Kool Smiles dental clinics for which Benevis provides business management and administrative services, agreed to pay $23.9 million to settle allegations of violating the False Claims Act by submitting false claims for payment to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid.  According to the government, Benevis and Kool Smiles clinics located throughout 17 states submitted false claims to state Medicaid programs for medically unnecessary pulpotomies (baby root canals), tooth extractions, and stainless steel crowns, in addition to seeking payment for pulpotomies that were never performed.  The government further alleged that Kool Smiles clinics routinely pressured and incentivized dentists to meet production goals through a system that disciplined “unproductive” dentists and awarded “productive” dentists with substantial cash bonuses based on the revenue generated by the procedures they performed.  The allegations originated in five whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Three of the whistleblowers -- former Kool Smiles employees Adam Abendano, Poonam Rai, and Robin Fitzgerald -- will receive a whistleblower award of more than $2.4 million from the proceeds of the government's recovery. DOJ

January 11, 2018

California announced a $102 million settlement with BP Energy Company and affiliates (BP) over allegations that it intentionally overcharged the State of California for natural gas that the State purchased under three successive contracts from March 2003 to August 2012. The contracts allowed the California Department of General Services, which buys natural gas for numerous state agencies and political subdivisions, to cap the price it would pay BP for specific volumes of gas. BP regularly quoted and charged the State of California prices that violated this cap and concealed its overpricing by providing false and misleading information. These acts constitute violations of the California False Claims Act. CA

August 18, 2017

Godwin Oriakhi, the owner of five Houston-area home health agencies, was sentenced to 480 months in prison for conspiring to defraud Medicare and the State of Texas’ Medicaid-funded Home and Community-Based Service (HCBS) and Primary Home Care (PHC) Programs of more than $17 million.  The HCBS and PHC Programs provided qualified individuals with in-home attendant and community-based services that are known commonly as “provider attendant services.” (PAS).  This case marks the largest PAS fraud case charged in Texas history. DOJ

November 17th, 2017

New York announced the indictment of Hin T. Wong ("Wong"), 49, of Manhattan, Mery Gooden, 58, of the Bronx, and three pharmacies. The indictment charges Wong, the owner of three Manhattan pharmacies – New York Pharmacy Inc. ("NY Pharmacy"), NYC Pharmacy Inc. ("NYC Pharmacy"), and New York Healthfirst Pharmacy Inc. ("NY Healthfirst") – for defrauding several government-funded healthcare programs, including Medicaid and Medicare, by falsely billing prescription refills and stealing over $3 million in reimbursement for medication they did not dispense. Wong was indicted for Grand Larceny in the First Degree, a class "B" felony, and other crimes. In addition, Mery Gooden, a pharmacist at NYC Pharmacy, was indicted for Grand Larceny in the Second Degree and other related crimes. NY

September 22, 2017

Illinois announced a $4.5 million settlement to resolve a lawsuit under the Illinois False Claims Act against 13 Chicago-area gas stations and two gas station owners for sales tax fraud. The lawsuit alleged that since 2002, defendants submitted false monthly sales tax returns to the Illinois Department of Revenue, resulting in millions of dollars of lost tax revenue to the state. The lawsuit alleged defendants operated the scheme by underreporting general merchandise sales and using inaccurate sales tax reporting rates. Ten of the gas stations are currently in operation and are owned by George Nediyakalayil, and Tito Kandarapallil co-owns one of the gas stations with Nediyakalayil. IL