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Page 17 of 42

September 26, 2019

Physician Philippe R. Chain will pay $300,000 to resolve allegations that he caused the submission of false claims to Tricare while working for telemedicine company CallMD. Chain allegedly issued and approved prescriptions for compounded medications, many of which were not medically necessary, without speaking to, examining, or otherwise having a physician-patient relationship with the patients.  USAO CT

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Lack of Medical Necessity, Other Government Health Programs, Provider Fraud,

September 17, 2019

Physician Alliance Ltd. (PAL) and its medical director agreed to pay $178,000 to resolve False Claims Act allegations for improperly billing Medicare for providing patients with electric acupuncture medical devices that is affixed behind patients' ears. Since Medicare does not reimburse for acupunctural devices, PAL allegedly billed Medicare for the “implantation of neurostimulator electrodes,” a procedure that requires surgery and for which Medicare reimburses in the thousands of dollars. The case was investigated out of the Eastern District of Pennsylvania. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,

September 17, 2019

Physician Alliance Ltd. and Richard Frey, D.O. will pay $178,400 to resolve allegations that they submitted false claims to Medicare.  When defendants provided patients with "P-Stim" devices, which are worn on a patient's ear and marketed as an acupuncture treatment, they billed Medicare for the implantation of neurostimulator electrodes, which is a surgical procedure for which Medicare reimburses thousands of dollars.  By contrast, Medicare does not reimburse for acupuncture or acupuncture devices.  USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Provider Fraud,

September 9, 2019

Dr. Augusto Castrillon of Texas has agreed to pay $2 million to settle allegations he fraudulently billed Medicare for medically unnecessary diagnostic tests in violation of the federal False Claims Act.  From 2009 to 2015, the owner and operator of Castrillon Family Clinic allegedly submitted false claims for transcranial doppler imaging studies, electromyography, nerve conduction studies, and autonomic function testing that were ordered for the same patients on a recurring basis.  The claims submitted by Dr. Castrillion were so excessive that they stood out as a significant statistical outlier in a proactive review of claims data by the U.S. Attorney’s Office.  USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud,

September 5, 2019

El Paso Integrated Physicians Group, P.A., several physicians in the group, and Accutrack Medical Claims Services, LLC, have agreed to pay $2.93 million to resolve a False Claims Act case filed by whistleblower Sergio Garcia alleging that they double-billed and over-billed government payors for the infusion drug Remicade (Infiximab).  Remicade is sold in single-use vials; defendants were alleged to have pooled Remicade from partially-used vials, diluted Remicade, and illegally imported drugs from Canada and other foreign countries.  USAO WD Tex

Tagged in: Dosage Fraud, FCA Federal, Medical Billing Fraud, Pharma Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

September 5, 2019

Dentist Santa Maria McKibbens has agreed to pay North Carolina $375,000 to resolve allegations that she submitted false claims to the North Carolina Medicaid Program by billing for dental restorations that were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy.  NC

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

August 16, 2019

2d Chance PLLC, a Kentucky-based substance abuse center, will pay $200,494 to resolve allegations under the False Claims Act that it entered into an arrangement with Compliance Advantage, LLC, a toxicology lab, whereby 2d Chance referred patients to Compliance Advantage for complex drug testing, and Compliance Advantage provided a no-cost chemistry analyzer to 2d Chance, allowing 2d Chance to perform some urine testing at its site and bill Medicaid for those services.  The financial arrangement violated the Anti-Kickback Statute.  EDKY

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

August 16, 2019

Kentucky-based Ultimate Care Medical Services, LLC, doing business as Ultimate Treatment Center, and its principal, Dr. Rose O. Uradu, have agreed to pay $1.4 million to resolve allegations that they submitted false claims to Mediare and Kentucky's Medicaid program for services that were not provided.  Defendants billed for "evaluation & management" services when patients visited the clinic to receive methadone, visits which did not include a medical examination, which is required to bill for evaluation &  management.  In addition, defendants billed for complex urine drug testing when they lacked the equipment to perform such testing, and issued buprenorphine prescriptions at an rate greater than authorized.  USAO ED KY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million.  According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals.  As part of the settlement, Seddon will receive a $200,000 relator’s share.  USAO SDAL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 18, 2019

Connecticut-based Comprehensive Pain and Headache Treatment Centers, LLC (CPHTC), and owner Mark Thimineur, M.D., have settled federal and state False Claims allegations of improperly submitting claims for urine tests that were not performed or were already part of drug screens paid for by Medicare and Medicaid.  As part of the settlement, they will pay $425,000.  USAO CT

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

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