Archive

July 9, 2019

Two chiropractors who owned the Kansas City Health and Wellness Clinic have agreed to pay $350,000 to settle False Claims allegations. Brothers Ryan Schell and Tyler Schell allegedly billed Medicare for medically unnecessary, unprovided, or uncovered treatments of peripheral neuropathy, which causes loss of sensation and/or burning sensations in the hands and feet. USAO KS

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

June 28, 2019

The nation’s largest operator of inpatient rehabilitation facilities (IRFs) has agreed to pay $48 million to settle allegations that it violated the False Claims Act. Three separate lawsuits filed by former contract physician Dr. Emese Simon, former director of therapy operations Melissa Higgins, and former medical director Dr. Darius Clarke, alleged a number of Encompass Health Corporation, f/k/a HealthSouth Corporation IDFs, falsely diagnosed patients with “disuse myopathy” and improperly admitted patients too sick or disabled to participate in physical therapy in order to earn higher reimbursements from Medicare. The whistleblowers’ collective share of the settlement is $12.4 million. DOJ; USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

June 27, 2019

Following a whistleblower suit, Fusion Physical Therapy and Sports Wellness, P.C., and its founder and CEO, Carolyn Sue Mazur, have agreed to pay $37,500 to settle charges of billing Medicare for physical therapy services performed by uncredentialed personnel. In addition the monetary penalty, Fusion and Mazur have also admitted to the misconduct. USAO SDNY

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

June 18, 2019

Nevada Heart & Vascular Center has agreed to pay $2.5 million to settle allegations that it accepted kickbacks from genetic testing companies, Natural Molecular Testing Corp. and Iverson Genetic Diagnostics, Inc., in exchange for referrals of Medicare patients. The alleged violations of the Anti-Kickback Statute and False Claims Act occurred for nearly a year in 2012. USAO NV

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

June 7, 2019

Robert A. Glazer and Marina Menino have been found guilty at trial for their actions directing a Medicare fraud scheme that billed $33 million to the government. Menino received kickbacks from Glazer in exchange for recruiting patients for his Glazer Clinic. Glazer then billed Medicare for services the patients did not need or did not receive, referred them to medically unnecessary home health or hospice services, and ordered durable medical equipment that they did not need or receive. Defendants will be sentenced in September 2019. DOJ; USAO C.D.Cal.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medicare, Provider Fraud,

May 30, 2019

Joseph P. Galichia, a cardiologist in Wichita, Kansas, will pay $5.8 million to resolve allegations under the False Claims Act that he and his practice, Galichia Medical Group, P.A., implanted cardiac stents in patients who did not need them, and billed Medicare, the Defense Health Agency, and the Federal Employees Health Benefits Program for these medically unnecessary procedures. Galichia will also be excluded from participating in federal healthcare programs for three years. The case was initiated by a whistleblower, Aly Gadalla, M.D., who filed a qui tam complaint. Dr. Gadalla will receive a whistleblower reward of $1.16 million. This is the third time Galichia had settled FCA claims against him and his practice. DOJ; USAO Kan

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 29, 2019

A doctor in South Carolina has agreed to pay $92,506.30 to settle allegations of accepting illegal payments from OK Compounding, LLC, in exchange for prescribing their pain creams to TRICARE patients. The False Claims Act violations allegedly occurred between February and May 2013, and involved “medical director fees” paid to Dr. Jerry Back that were in reality, kickbacks. This was the eighth kickback settlement in the Northern District of Oklahoma since the beginning of the year. USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud, Provider Fraud,

May 9, 2019

Carolina Physical Therapy and Sports Medicine, Inc. agreed to pay $790,000 to settle a whistleblower lawsuit alleging the company knowingly submitted false claims to Medicare and TRICARE. According to former employee Hilary Moore, Carolina PT submitted claims for group physical therapy services that were billed as though they were one-on-one sessions. Additionally, claims for certain services performed by physical therapy assistants were billed as though they were performed under the supervision of qualified therapists. For exposing the fraudulent conduct, Moore will receive a relator’s share of $142,200. USAO SC

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

May 2, 2019

Chimes Delaware, which provides services to individuals with developmental disabilities in Delaware, will return $4.5 million in Medicaid funding to the state to resolve claims of billing errors in its supported employment programs and transportation services. Chimes also agreed to institute new internal controls and billing procedures. DE

Tagged in: Ambulance, Medicaid, Medical Billing Fraud, Provider Fraud,

April 25, 2019

Two pain management clinics in Northern Virginia, National Spine and Pain Centers and Physical Medicine Associates, will pay $3.3 million to resolve a False Claims Act case first filed by a whistleblower who was a former physician assistant at one of the clinics. The clinics were alleged to have billed services provided by physician assistants and nurse practitioners as if they were provided by a physician, to have ordered medically-unnecessary urine drug tests, and to have submitted claims for urine drug testing that did not comply with the Stark Law and/or Anti-Kickback Statute. USAO EDVA

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

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