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March 7, 2022

Redwood Toxicology Laboratory has agreed to pay nearly $4.8 million to settle allegations that the California-based urine drug testing service overcharged the Connecticut Medicaid program for certain laboratory services, in violation of Connecticut’s “Most Favored Nation” regulation, which provides that the state should not be charged more than the lowest price charged to third parties.  The settlement covered claims submitted between January 2015 through February 2018.  USAO CT

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud,

March 7, 2022

MOX Services LLC, formerly known as CV&I AREVA MOX Services LLC (MOX), has agreed to a $10 million settlement to resolve allegations of violating the False Claims Act.  As the prime contractor for a federal facility in South Carolina, MOX was responsible for confirming receipt of materials from any subcontractors before presenting claims to the government.  According to the DOJ, however, MOX knowingly sought reimbursement from the Department of Energy for millions of dollars of materials not received from one of its subcontractors, Wise Services Inc., and which it submitted to the DOE in exchange for kickbacks from Wise.  DOJ

Tagged in: FCA Federal, Government Procurement Fraud,

March 3, 2022

New York-based ophthalmologist Ameet Goyal, M.D., who owned and operated Rye Eye Associates, has been sentenced to 8 years in prison and ordered to pay $3.6 million in forfeiture as well as $3.6 million in restitution for submitting $3.6 million in upcoded charges to Medicare, private insurers, and patients between 2010 and 2017.  While facing charges for healthcare fraud in 2020, Goyal also falsely certified that he was not facing any criminal charges in order to obtain over $600,000 in loans from the Paycheck Protection Program.  USAO SDNY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Upcoding,

February 23, 2022

TriMark USA, LLC and related entities will pay $48.5 million to resolve claims brought in a whistleblower lawsuit alleging that they improperly manipulated federal contract set-asides for service-disabled, veteran-owned small businesses (SDVOSB) by enlisting small business to secure the contracts while TriMark actually performed all of the work and received most of the benefits of the federal contract.  In addition, former TriMark executive Kimberley Rimsza has agreed to pay $100,000 to resolve claims against her.  The whistleblower, Fox Unlimited Enterprises, LLP, will receive an award of $10.9 million.  USAO ND NY; USAO ED WA

Tagged in: FCA Federal, Government Procurement Fraud, Set-Asides and Preferences, Whistleblower Case, Whistleblower Rewards,

February 2, 2022

New York healthcare provider The Door - A Center for Alternatives has agreed to pay $12.9 million to resolve claims that it submitted false claims for reimbursement to New York's Indigent Care Pool, which is funded by Medicaid.  The Door was required to submit annual cost reports to New York reporting figures including the number of "threshold visits" to its ambulatory diagnostic and treatment center.  A qui tam case initiated by two whistleblowers alleged that defendant knowingly inflated the number of threshold visits to increase payments.   SDNY

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Other Government Health Programs, Provider Fraud, Whistleblower Case,

January 28, 2022

Hayat Pharmacy agreed to pay over $2 Million to resolve allegations that it submitted false claims to Medicare and Medicaid for certain prescription medications from its 23 locations. The government alleged Hayat Pharmacy submitted false claims for two prescription medications, a topical cream consisting of iodoquinol, hydrocortisone, and aloe, and a multivitamin with the trade name Azesco.  Hayat Pharmacy allegedly switched Medicaid and Medicare patients from lower cost medications to the higher cost medications without any medical need and/or without a valid prescription. As part of the settlement, Hayat Pharmacy agreed to conduct annual training concerning waste, fraud and abuse, and compliance with rules concerning medication switches. USAO WI

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Pharma Fraud, Whistleblower Case,

January 31, 2022

Cardinal Health agreed to pay more than $13 Million to settle allegations it violated the Anti-Kickback Statute and False Claims Act by paying “upfront discounts” to its physician practices. According to the government, Cardinal Health recruited new customers by offering and paying cash bonuses that were not attributable to identifiable sales or were purported rebates which Cardinal Health’s customers had not actually earned. In connection with the settlement, the whistleblowers who brought the case will receive approximately $2.6 million of the recovery. USAO MA

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

January 14, 2022

Conduent Education Services LLC, f/k/a Xerox Education Services LLC, d/b/a ACS Education Services LLC (CES)—a contractor that serviced student loans for lenders—has agreed to pay $7.9 million to resolve allegations of submitting or causing the submission of false claims to the Department of Education (DOE) between 2006 and 2016.  In violation of Federal Family Education Loan (FFEL) program rules and the False Claims Act, CES allegedly failed to accurately report required data on the impact of monthly student loan repayments, principal capitalization, and other changes to DOE.  Under a prior remediation plan, CES paid DOE $1.4 million to partially resolve its liability, which it received credit for in the current settlement.  DOJ

Tagged in: Education Fraud, FCA Federal,

January 12, 2022

Six medical practices affiliated with Interventional Pain Management Center P.C. (IPMC), as well as physician-owner Dr. Amit Poonia, have agreed to pay nearly $7.5 million to resolve allegations of defrauding Medicare and the Federal Employees Health Benefit Program.  In a qui tam suit by Anu Doddapaneni and Christian Reyes, the whistleblowers alleged that Poonia and IPMC violated the False Claims Act by using a billing code that mischaracterized P-Stim and NeuroStim treatments—which transmit electrical pulses through needles placed just under the skin of a patient’s ear—as surgical implantation requiring anesthesia.  USAO EDNY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Misrepresentations, Other Government Health Programs, Provider Fraud, Whistleblower Case,

January 12, 2022

A diabetic shoe company, Foot Care Store, Inc., d/b/a Dia-Foot, and its President and CEO, Robert Gaynor, have agreed to pay $5.5 million to resolve allegations of billing Medicare and Medicaid for custom diabetic shoe inserts when in fact, their inserts were made using generic foot models.  The alleged misconduct occurred between 2013 and 2018 and was revealed in a whistleblower’s 2018 qui tam suit.  In addition to the monetary penalty, Dia-Foot has entered into a three-year Integrity Agreement that requires the company to implement updated policies and procedures and submit to quarterly independent review of its claims to Medicare and Medicaid.  USAO SDFL

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Whistleblower Case,

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