Archive

March 8, 2022

Eugene Sisco, III of Kentucky, the owner and operator of several medication assisted treatment (MAT) clinics for opioid addiction, has been sentenced to over 10 years in prison and ordered to pay $5.7 million in restitution, after being convicted of healthcare fraud.  Sisco was found to have tricked Medicaid patients into paying hundreds of dollars in cash each month for MAT services which he later billed and was reimbursed by Medicaid for.  Sisco’s laboratory, Toxperts, LLC, was also found to have billed Medicare for medically unnecessary urine drug tests, causing a loss of over $2 million to CMS.  USAO EDKY

March 7, 2022

Pharmaceutical company Mallinckrodt ARD LLC will pay $260 million to resolve allegations that it violated the False Claims Act in the sale and marketing of its drug H.P. Acthar Gel.  The government intervened in whistleblower actions alleging that Mallinckrodt and its predecessor Questcor Pharmaceuticals Inc. knowingly underpaid state Medicaid programs by improperly calculating amounts it owed under the Medicaid Drug Rebate Program, and unlawfully used a foundation as a conduit to subsidize co-payments.  With respect to the Medicaid rebate claims, which represent $234.7 million of the settlement, defendants were alleged to have calculated rebate amounts as if Acthar was a “new drug” first marketed in 2013, rather than a drug that had been approved since 1952.  By using 2013 for Acthar’s Base Date Average Manufacturer Price (AMP), the company ignored price increases prior to 2013 and fraudulently reduced Acthar drug rebates.  With respect to the copayment fraud claims, which represent $26.3 million of the settlement, defendants were alleged to have violated the Anti-Kickback Statute by subsidizing copayments through payments to three funds that Mallinckrodt had a foundation set up to induce Medicare-reimbursed purchases of Acthar, using the subsidies to counteract doctor and patient concerns about the drug’s high cost.  The whistleblower in the Medicaid rebate case, James Landolt will receive an award of $24.7 million, representing 20% of the $123.6 million federal share of that settlement; the relator’s share for the state share of the settlement was not announced.  The whistleblowers in the copayment case, Charles Strunck and Lisa Pratta, will receive an award of $4.9 million, representing 19% of that settlement.  The settlement includes a five-year corporate integrity agreement (CIA) with monitoring provisions.  DOJ; USAO MA; USAO EDPA

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

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

February 18, 2022

Muhammad Ateeq, of Rawalpindi, Pakistan, was sentenced to 12 years in prison and ordered to pay more than $50 million in restitution for forfeiture for submitting fraudulent claims to Medicare for home health services. Ateeq acquired and managed home health agencies in the United States, using false identities. He then used these home health agencies to submit fraudulent Medicare claims totaling over $40 million for services not rendered. The ill-gotten gains were laundered through U.S. bank accounts designated by overseas customers of overseas money transmitting businesses. Cash payments were then transmitted to accounts in Pakistan which Ateeq controlled. Fraud proceeds were also used to purchase luxury items which were delivered to Ateeq’s Dubai associates. DOJ

February 10, 2022

Bradley Jason Kantor, 49, will spend 10 years in federal prison after being found guilty of paying kickbacks for referrals to his immunotherapy and antigen business, Mobile Diagnostic Imaging, Inc. (MDI). MDI received more than $12 million from the scheme in which MDI submitted approximately $42 million in false claims to United Healthcare, for which services were never rendered. USAO SDFL

February 9, 2022

The Catholic Medical Center (CMC) will pay $3.8 million for violations of the False Claims Act and the Anti-Kickback Statute. Over a ten-year period, the CMC provided call coverage services to a cardiologist, for free, in exchange for lucrative referrals to their hospital, resulting in receipt of millions of dollars for services and medical procedures. USAO NH

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

February 1, 2022

Two North Carolina medical providers will pay nearly $1.5 million combined for submitting false claims to the Medicaid program. Knowles, Smith, & Associates LLP will pay $1,150,000 to resolve allegations spanning five years of failure to monitor their anesthesia billing by not providing services billed, administering medically unnecessary procedures, or failing to maintain sufficient supporting documentation. Stacy Benton Lewis, M.D., and the Center for Women’s Health, P.A. will pay $340,000 to resolve false billing allegations covering a four-year period for submitting claims for complex visits that did not occur. NC DOJ

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