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November 14, 2022

The Florida Birth-Related Neurological Injury Compensation Association and a related entity, which were created by the State of Florida to provide compensation for the medical, rehabilitative and custodial care of children who suffered certain categories of birth-related neurological injuries, will pay $51 million to resolve a whistleblower’s qui tam lawsuit, pursued on a non-intervened basis, alleging that they fraudulently caused NICA participants to submit their healthcare claims to Medicaid rather than NICA, in violation of Medicaid’s status as the payer of last resort under federal law.  The relators, Veronica Arven and the estate of Theodore Arven III, will receive $12,750,000 as their share of the recovery.  DOJ

November 3, 2022

Teva Pharmaceuticals, Ltd., subsidiary Teva Pharmaceuticals USA, and its affiliates will pay $523 million to New York State for their role in fueling the opioid crisis. Injunctive relief includes a ban on high-dose opioids and prescription savings programs, prohibitions on marketing and funding third parties that promote opioids, restrictions on political lobbying, and monitoring and reporting of off-label use of fentanyl nasal spray products. NYAG

November 3, 2022

Titan Medical Compliance, LLC, and its chiropractor owner Timothy Warren, have been ordered to pay over $15 million to resolve claims that they falsely marketed auricular electro-acupuncture devices as FDA-approved and Medicare-reimbursable, when in fact they are not.  The judgment against Warren and Titan is the latest in a federal investigation into the improper billing of these non-surgical devices.  USAO EDPA

November 1, 2022

Electronic health record technology vendor Modernizing Medicine, Inc. (“ModMed”) has agreed to pay $45 million to resolve allegations, including by its former VP of Product Management, that it both received and provided illegal kickbacks in exchange for referrals.  According to the government and whistleblower Amanda Long, ModMed engaged in schemes with Miraca Life Sciences, Inc. (now known as Inform Diagnostics) to receive kickbacks in exchange for recommending its users for Miraca’s lab services, and to provide its EHR technology free to healthcare providers to entice them to direct lab orders to Miraca and add to ModMed’s user base.  Long will receive about $9 million of the settlement with ModMed. DOJ

October 31, 2022

Felix Amos of Houston, TX will serve 30 months in federal prison and will pay over $21 million in restitution for his role in a Medicare fraud scheme carried out with two other co-defendants. From 2010 to 2015, Amos owned and operated home health companies Dayton Health Bridges, Access Practical Solutions, Advanced Holistic, GetUpandWalk Inc., and Guaranty Home Health Agency. Amos and his co-conspirators submitted false claims to Medicare for patients that did not need or receive services, including deceased or incarcerated persons, and for services not ordered by a physician. USAO SDTX

October 18, 2022

Carter Healthcare LLC, affiliates CHC Holdings and Carter-Florida, president Stanley Carter, and Chief Operations Officer Bradley Carter have agreed to pay $23 million and $7.2 million to settle two whistleblower cases alleging violations of the False Claims Act.  The first case, filed in the Western District of Oklahoma, alleged that the Oklahoma-based home health company paid illegal kickbacks to physicians under the guise of medical directorships in order to induce referrals.  The second case, filed in the Southern District of Florida by former therapists Sharon Mahaffey and Mark Brimer, alleged that Carter Healthcare billed Medicare for medically unnecessary therapy and upcoded patient diagnoses for higher reimbursements.  As part of the settlements, defendants Stanley and Bradley Carter have agreed to be excluded from participating in government healthcare programs for 5 years, and whistleblowers Mahaffey and Brimer will split a $1.3 million relator’s share.  USAO WDOK; USAO SDFL

October 17, 2022

Sutter Health has agreed to pay more than $13 million to settle claims of billing Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program for quantitative urine testing that were in fact performed by third-party labs.  The company has already paid more than $6.5 million and is due to pay the remaining $6.5 million in the next 30 days.  USAO NDCA

October 14, 2022

The owners of two Texas-based home health clinics have been sentenced to 10 years in prison each after a jury convicted them of conspiring to commit healthcare fraud.  Alfred Olotin Alatan, who owned Colony Home Health Services, and Francis Ekene, who owned Milten Medical Clinic, allegedly paid recruiters for patient information, then billed providers for home health services, regardless of need.  Co-conspirators Susana Bermudez and Rita Kpotie Smith, both of whom operated the clinics under Alatan’s direction, are currently serving 2.5 years and 5 years in prison, respectively.  USAO SDTX

October 12, 2022

Four pharmacies have agreed to pay over $6.8 million to settle a qui tam suit that alleged they defrauded TRICARE and the Federal Employees Health Benefits Program, in violation of the False Claims Act.  According to a former accountant for one of the pharmacies, DermaTran Health Solutions, LLC; Pharmacy Insurance Administrators, LLC; Legends Pharmacy; TriadRx; and Lake Side Pharmacy created a program to waive mandatory copays for beneficiaries of federal health insurers, overcharged the government for compounded pain creams, and traded out-of-network prescriptions with other pharmacies, which constituted a kickback.  USAO NDGA

October 6, 2022

A man in Missouri who was convicted of committing healthcare fraud through various durable medical equipment companies has been sentenced to 3 years in prison and ordered to repay $7.5 millionJamie McCoy, who owned or operated AE Wellness LLC, Summit Medical Supply, Patriot Medical Supply, and DME Device Co., had worked in conjunction with marketing firms and a telemedicine doctor to cause fraudulent claims derived from illegal kickbacks to be submitted to Medicare and TRICARE.  After the scheme was discovered and McCoy and AE Wellness were suspended from further participation, two of McCoy’s associates opened the other companies to continue the fraud, while concealing McCoy’s role in the operation.  USAO EDMO
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