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September 13, 2023

Texas-based Oliver Street Dermatology Management LLC, which manages dermatology practices, surgical centers, and pathology labs across the country, has agreed to pay $8.9 million to resolve self-reported violations of the Anti-Kickback Statute, Stark Law, and False Claims Act.  The company revealed in 2021 that some of its former senior managers had fraudulently increased the purchase price of 11 dermatology practices acquired between 2013 and 2018 in exchange for referrals.  Claims arising from those referrals were found to have been submitted to Medicare.  USAO NDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Reporting to Government,

August 31, 2023

Watermark Retirement Communities LLC, which manages 79 retirement homes across the country, has agreed to pay $4.25 million to settle claims of violating the Anti-Kickback Statute and False Claims Act.  According to a lawsuit launched by David Freeman, the former director of strategic growth for a nationwide home health agency (HHA), between 2014 and 2020, Watermark solicited and received kickbacks from the HHA in exchange for referrals of Medicare beneficiaries from 8 of its retirement facilities in 5 states, including Arizona, Connecticut, Delaware, Florida, and Pennsylvania.  Watermark then caused false claims to be submitted in connection with those referrals.  DOJ

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

August 18, 2023

The owner and operator of Georgia-based LabSolutions LLC has been sentenced to 27 years in prison for submitting over $463 million in medically unnecessary genetic and other laboratory tests derived from illegal kickbacks.  Minal Patel allegedly paid kickbacks to telemarketing companies to talk Medicare beneficiaries into getting the tests, then paid kickbacks to telemedicine doctors who signed orders for the tests without ever speaking to beneficiaries to determine need.  As a result of these fraudulent actions, Medicare paid over $187 million in reimbursement, with Patel receiving over $21 million personally, between 2016 and 2019.  DOJ

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

July 14, 2023

Electronic health record technology vendor NextGen Healthcare Inc. has agreed to pay $31 million to resolve a whistleblower’s allegations that it misrepresented the capabilities of certain software and improperly induced users to recommend the software.  According to two users of the NextGen’s software, Toby Markowitz and Elizabeth Ringgold, the company allegedly violated the False Claims Act by concealing from a certifying entity that its technology lacked critical but required functions. Additionally, the company allegedly violated the Anti-Kickback Statute by giving credits worth up to $10,000 to customers whose recommendation of NextGen’s EHR software led to a new sale.  For launching a successful qui tam case, the whistleblowers will receive and share a $5.6 million share of the recovery.  DOJ

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

June 21, 2023

Skilled nursing facility Alta Vista Healthcare & Wellness Centre and its management company Rockport Healthcare Services have agreed to pay $3.8 million to resolve allegations that it paid kickbacks to physicians to induce referrals of Medicare and Medicaid beneficiaries to its center.  The violations of the federal Anti-Kickback Statute, federal False Claims Act, and California False Claims Act were uncovered during a government investigation, and showed illegal kickbacks in the form of cash, gifts, and salaries paid from 2009 through 2019.  CA AG; DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, SNF,

May 31, 2023

VHS of Michigan Inc., d/b/a, The Detroit Medical Center, Vanguard Health Systems Inc., and Tenet Healthcare Corporation will pay nearly $30 million for causing the submission of false or fraudulent claims to Medicare. From January 1, 2014 through December 31, 2017, DMC, Vanguard, and Tenet violated the Anti-Kickback Statute when they provided the services of mid-level practitioners to 13 physicians at no cost or below fair market value. The physicians were selected for their high number of referrals, which DMC hoped would cause an increase in referrals to their facilities. Whistleblower Dr. Jay Meythaler will receive $5.2 million as part of the settlement. DOJ

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

April 28, 2023

Joyce Agu, of Sugar Land, TX, will spend 60 months in prison and will pay over $3 million in restitution for conspiring to pay and receive kickbacks for services billed to Medicare. Agu paid others to certify that her clients were eligible for home health services, which they were not, but she used the certifications anyway as a basis to submit false claims to Medicare. TX AG

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

April 20, 2023

Dr. Paul S. Koch, Koch Eye Associates, and Claris Vision violated the False Claims Act by paying kickbacks to optometrists who referred their patients to Koch and his companies for laser-assisted cataract surgery. Over a five-year period, from 2013 to 2017, Koch and his practices submitted false claims to Medicare based on those kickbacks. Koch will pay nearly $1.2 million to resolve the qui tam whistleblowers’ claims, and the two whistleblowers will receive $256,534.84 from the settlement. USAO RI

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

April 20, 2023

Miami doctors Lawrence Alexander and Dean Zusmer were sentenced to 33 months and 96 months in prison, respectively, for their scheme to defraud Medicare of $31 million. Zusmer, a chiropractor and DME company owner, paid kickbacks to acquire patient referrals and signed doctors’ orders, using overseas call centers to solicit unnecessary prescriptions from patients and telemedicine companies. Alexander, an orthopedic surgeon and co-owner of another DME company, concealed his participation by putting the DME company in the name of one of his family members. The companies received over $15 million from Medicare through their fraud. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare, Provider Fraud,

April 17, 2023

Sibley Hospital and parent company Johns Hopkins Health System will pay $5 million to resolve allegations of Stark Law violations. Over a four-year period, from 2008 to 2011, Sibley billed Medicare for ten cardiologists’ services to whom they were already paying compensation above fair market value. The Stark Law prohibits such an arrangement, to ensure that medical decision-making is not influenced by improper financial incentives but instead is based on the patient’s best interests. Sibley and Johns Hopkins self-disclosed the impropriety. DOJ

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

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