Archive

April 27, 2021

Indivior plc and Indivior Inc., will pay $300 million to settle claims from all 50 states, the District of Columbia, and Puerto Rico, alleging they caused the misuse of state Medicaid funds by falsely marketing the drug Suboxone. Suboxone is used by recovering opioid addicts to reduce withdrawal symptoms. According to the governments, Indivior promoted the sale and use of Suboxone for unsafe, ineffective, and medically unnecessary purposes, including by claiming it was less susceptible to abuse even though the active ingredient, buprenorphine, is a powerful opioid itself. Additionally, the company took steps to fraudulently delay the entry of generic alternatives in order to control pricing. The settlement resolves six whistleblower suits pending in New Jersey and Virginia. Indivior previously paid $600 million to resolve federal claims, and former parent company Reckitt Benckiser previously paid $1.4 billion to resolve the same. CA AG; FL AG; MI AG

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Misrepresentations, Whistleblower Case,

April 21, 2021

Tennessee-based Anesthesia Services Associates, PLLC d/b/a Comprehensive Pain Specialists (CPS) and its four majority owners have agreed to pay a total of $4.1 million to resolve allegations of violating the federal False Claims Act and Tennessee Medicaid False Claims Act. According to the government, CPS billed Medicare and TennCare for medically unnecessary or non-reimbursable genetic tests, psychological tests, specimen validity tests, and urine drug tests, as well as medically unnecessary or non-reimbursable acupuncture. For bringing a successful qui tam suit, the whistleblowers in this case will receive a relator’s share of over $610,000. USAO MDTN

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 20, 2021

In order to resolve a whistleblower suit alleging violations of the False Claims Act, Massachusetts Eye and Ear and its related entities have agreed to pay over $2.6 million. Over an eight-year period ending in 2020, Massachusetts Eye and Ear allegedly made a habit of submitting false claims to Medicare and Medicaid for office visits that were not reimbursable under program rules. Altogether, the government programs were defrauded of over a million dollars. As a reward for blowing the whistle, the unnamed relator will receive a 15% share of the settlement proceeds. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 14, 2021

The owner of a Florida-based telemarketing call center, Ivan Andre Scott, has been sentenced to 10 years in prison after being convicted of conspiracy to commit healthcare fraud in connection with a $3.3 million fraud scheme against Medicare. According to evidence presented at trial, Scott made telemarketing calls to Medicare beneficiaries to persuade them to take expensive genetic tests, paid illegal kickbacks to telemedicine companies in exchange for doctor authorizations, and received illegal kickbacks from laboratories in exchange for providing them with the genetic tests. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare,

April 13, 2021

After pleading guilty to one count of conspiracy to commit healthcare fraud, James Spina of Dolson Avenue Medical (DAM) in New York has been sentenced to 9 years in prison and ordered to pay over $9.7 million in restitution and over $9.1 million in forfeiture. Because he did not meet legal requirements for owning and operating a medical corporation, Spina went to great lengths to conceal his role in DAM and at least four other medical corporations, which he then used to run a widespread fraud scheme against Medicare and other health insurers. The misconduct involved submitting fraudulent claims for medically unnecessary services and services not rendered, double billing for services, fabricating medical records, and obstructing audits by Medicare and other health insurers. USAO SDNY

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Medicare,

April 6, 2021

Health Net Federal Services LLC paid over $97 million to resolve claims that it overcharged the Department of Veterans Affairs as the third-party administrator under the Patient-Centered Community Care Program. Health Net's alleged overbilling, which included billing the VA for duplicate claims and failing to pass on provider rate savings to the VA, was discovered in an audit by the VA Office of the Inspector General. USAO EDCA

Tagged in: Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs,

April 1, 2021

Pharma company Bristol-Myers Squibb will pay $75 million to settle a False Claims Act action, filed by a whistleblower, alleging that the company failed to pay amounts it owed under the Medicaid Drug Rebate Program. That program, the MDRP, requires drug manufacturers to report the Average Manufacturer Prices (AMPs) of their Medicaid-covered drugs to the government; the higher the reported AMPs, the greater the rebate owed by the pharma company to the government. The whistleblower alleged that Bristol-Myers systematically under-reported their AMPs for a number of its drugs, including by reducing service fees it paid to wholesalers and excluding the value of price appreciation provisions in wholesale contracts. Of the total settlement, $41 million will be paid to the federal government, and the remainder to states participating in the settlement. The government did not intervene, and the action was pursued by the whistleblower, Ronald J. Streck, who will receive an undisclosed share of the settlement. USAO EDPA

Tagged in: Drug and DME Pricing, FCA Federal, Healthcare Fraud, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

March 26, 2021

Following two whistleblower complaints, a former owner of a now-defunct diagnostic testing laboratory in North Carolina and South Carolina has agreed to pay $2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act. Together with other agents of Physicians Choice Laboratory Services (PCLS), Phillip McHugh allegedly offered and provided benefits to physicians in exchange for referrals of patient samples, causing false claims to be submitted to Medicare. A second defendant in the case, former sales representative and manager Manoj Kumar, has already paid approximately $650,000 to resolve similar claims. USAO WDNC

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

March 24, 2021

Two men in Mississippi have been sentenced to 7 years in prison and ordered to pay over $16 million in restitution to Medicare, TRICARE, and Express Scripts, as well as forfeiture of close to $1 million, for their roles in a multimillion-dollar healthcare fraud scheme. Dempsey Bryan Levi and Jeffrey Wayne Rollins, the operators of the Gardens Pharmacy, LLC, had previously admitted to soliciting and incentivizing recruiters to obtain prescriptions for highly reimbursed compounded medications, and soliciting and incentivizing doctors to authorize those prescriptions. USAO SDMS

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

March 23, 2021

The former owner of Shape of Behavior (TSOB), a Texas-based therapy service provider for children with autism, has agreed to pay $2.7 million to resolve allegations that nine of the provider’s locations submitted improper claims to TRICARE. The misconduct was uncovered by TRICARE’s managed care support contractor, Humana Military Program Integrity, and involved claims that could not be substantiated by medical records, claims involving excessive hours by individual providers, and misrepresentations of the identities of actual rendering providers. USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

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