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July 8, 2019

Anthony Camillo, the owner of Illinois-based Allegiance Medical Laboratory and AMS Medical Laboratory, has been sentenced to 2.5 years in prison and ordered to pay $3.5 million in restitution for defrauding Medicare and Medicaid.  According to the DOJ, Camillo paid Missouri-based marketers between $150-$200 for urine and saliva samples sent to his labs.  His conduct incentivized other fraudulent conduct, including medically unnecessary testing of disabled and elderly patients living in residential care facilities, and the use of doctors’ names on test orders without the doctors’ knowledge.  USAO EDMO

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare,

July 5, 2019

A New York doctor is the latest defendant in a widespread OK Compounding pharmacy fraud scheme to settle with the government.  From 2014 to 2015, Dr. George Lehner allegedly prescribed compounded pain creams for his Medicare patients in exchange for an hourly “medical director fee” by OK Compounding LLC.  To settle the case against him, Lehner will pay about $130,000.  USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

June 26, 2019

A patient recruiter in Michigan has been sentenced to 5 years in prison and ordered to pay $1.5 million in restitution for taking part in a three-year scheme to defraud Medicare. Defendant Sophia Eggleston had allegedly solicited and received kickbacks in exchange for her referrals, causing Medicare to pay $1.5 million to a home health agency connected to the fraud scheme.  DOJ

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

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 11, 2019

Two additional co-defendants in a recently reported home health fraud case have been sentenced to 6-10 years in prison and ordered to pay over $4.3 million each for their involvement.  Angela Avetisyan and Ashot Minasyan, the co-owners and operators of Fifth Avenue Home Health, paid kickbacks to Marina Merino and other patient recruiters to bring Medicare patients to a clinic owned by Robert Glazer.  In exchange, they received referrals from Glazer’s clinic for home health services that were allegedly medically unnecessary.  DOJ; USAO CDCA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity,

June 11, 2019

A Maryland-based medical device manufacturer facing criminal charges and civil charges under the False Claims Act has agreed to pay $15 million to settle all claims.  According to former employee and whistleblower John Murtaugh, when the company discovered that its MicroMatrix wound dressing powder was contaminated with high levels of endotoxins, it allegedly removed certain MicroMatrix products off the market, but failed to report the removal to the FDA and disclose the reason to doctors, hospitals, and its own sales representatives.  ACell also allegedly caused false claims to be submitted to federal healthcare programs by directing its sales representatives to market the product as safe and effective, providing coding recommendations designed to elicit higher payments from Medicare, and providing improper inducements to encourage use of its product.  As part of the settlement, Murtaugh will receive $2.3 million, and ACell will enter into a 5-year corporate integrity agreement.  DOJ

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

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,

June 5, 2019

Opioid manufacturer Insys Therapeutics will pay $225 million to resolve federal criminal and civil claims against it regarding the unlawful marketing of its drug Subsys, including the payment of kickbacks to providers through sham "speaker programs" that rewarded practitioners who increased their Subsys prescribing, as well as jobs for prescribers' relatives and friends, and lavish meals and entertainment.  $195 million of the settlement will be paid to resolve False Claim Act allegations in five separate whistleblower lawsuits in which the government intervened in 2018; the whistleblower reward shares have not yet been determined.  To resolve the criminal claims, Insys will pay $2 million and forfeit $28 million; its operating subsidiary will plead guilty to wire fraud and related charges.  In addition, Insys entered into a five-year Corporate Integrity Agreement and a five-year deferred prosecution agreement. Previously, five former Insys executives were convicted of racketeering in connection with Subsys marketing.  DOJ; USAO Mass

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

June 3, 2019

Rialto Capital Management LLC (Rialto) and its former affiliate, RL BB-IN KRE LLC (RL BB), have agreed to pay $3.6 million to resolve allegations that a RL BB hospital violated the Anti-Kickback Statute, the Stark Law, and the False Claims Act.  A qui tam lawsuit filed by Dr. Abdul Buridi had revealed that Indiana-based Kentuckiana Medical Center, under Rialto’s direction, had provided personal loans to two referring doctors and then failed to collect on those loans after they became due in full.  Of the $3.6 million recovered, Dr. Buridi will receive $612,000.  DOJ

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

June 3, 2019

A former physician’s assistant in New Hampshire has been sentenced to 4 years in prison for writing prescriptions of a fentanyl spray in exchange for over $49,000 in kickbacks masked as speaker honorariums.  After being approached by a drug manufacturer in 2013, Christopher Clough wrote upwards of 750 prescriptions for the spray, which was intended for management of breakthrough cancer pain (BTCP).  Over 215 of those prescriptions were for Medicare and TRICARE patients and led to payments of over $2.1 million by Medicare and almost $600,000 by TRICARE.  On top of the kickback charges, Clough was accused of causing patient harm for prescribing the drug, in high doses, to patients who didn’t have BTCP, and then rebuffing patient and family requests to get off the drug.  USAO NH

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicare, Other Government Health Programs,

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