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November 9, 2021

Kaléo, Inc., a pharmaceutical manufacturer in Virginia, has agreed to pay $12.7 million to resolve a whistleblower’s allegations that it violated the Anti-Kickback Statute and False Claims Act in claims submitted to Medicare, TRICARE, and the Federal Employees Health Benefits Program.  Between 2017 and 2020, kaléo allegedly provided kickbacks to physicians and their staff to induce and reward them for prescribing Evzio, a higher-priced version of a drug used to reverse opioid overdoses and which often requires prior authorization.  Kaléo also allegedly directed pharmacies to submit false prior authorizations and dispense Evzio without collecting required co-pays.  USAO MA

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

November 8, 2021

Florida-based medical device company Arthrex Inc. has agreed to pay $16 million and enter into a five-year corporate integrity agreement to resolve allegations of paying kickbacks to a Colorado-based orthopedic surgeon in exchange for the surgeon’s use and recommendation of its products.  According to a qui tam suit by whistleblower Joseph Shea, the kickbacks were disguised as royalty payments for the surgeon’s contributions to Arthrex’s SutureBridge and SpeedBridge products.  For his role in the case, Shea will receive a relator’s share of $2.5 million.  USAO MA

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

November 5, 2021

Two men who pleaded guilty to causing $134 million in false claims to be submitted to Medicare and CHAMPVA have been sentenced to federal prison and ordered to pay restitution of over $29 million.  Michael Nolan of Florida was sentenced to 6.5 years, while Richard Epstein of Colorado was sentenced to about 5 years.  Using a telemarketing company called REMN Management LLC, as well as a telemedicine company called Comprehensive Telcare LLC, Nolan and Epstein had bribed physicians to sign medically unnecessary orders for durable medical equipment, which they then sold to co-conspirators as support for the false claims.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Other Government Health Programs,

November 1, 2021

Geisinger Community Health Services, based in Pennsylvania, has agreed to pay over $18.5 million to resolve its liability following a self-disclosure of violations of the False Claims Act.  The violations occurred between 2012 and 2017 and involved physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients.  USAO MDPA

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, Provider Fraud,

October 28, 2021

Rehab Authority, LLC, a physical therapy provider in Minnesota, has agreed to pay $4 million to resolve allegations by whistleblower Cami Lane that it violated the False Claims Act.  RehabAuthority clinics had allegedly submitted false claims to Medicare, Medicaid, TRICARE, and the Veterans Health Administration for one-on-one outpatient physical therapy that was not provided.  USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

October 25, 2021

Curant, Inc., which owns pharmacies in Florida and Georgia, has agreed to pay $4.6 million to resolve allegations of paying kickbacks to a third-party marketer, waiving mandatory copays from patients, and overbilling TRICARE for compound pain and scar creams.  The alleged misconduct occurred between 2013 and 2015.  USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

October 22, 2021

Texas doctors Robert Wills and Brannon Frank, who previously operated Austin Pain Associates, will pay $3.9 million to resolve allegations that they billed federal and state healthcare programs for medically unnecessary urine drug tests that were performed at Austin Pain Associates’ in-house lab.  The investigation was initiated after a whistleblower complaint was filed by former Austin Pain Associates employees Jennifer Nuessner and Robert Hoffman; they will receive approximately $618,000 from the federal share of the settlements. DOJ

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

October 21, 2021

Boulder, Colorado nonprofit The Center for Severe Weather Research paid $2.4 million to resolve allegations of fraud in federal grants received from the National Science Foundation, NASA, and NOAA.  CSWR was alleged to have improperly requested drawdowns from federal grants for expenses it had not incurred, and to have improperly retained interest accrued on federal funds received but not yet needed.  In addition, two CSWR principles, Ling Chan and Joshua Wurman, agreed to pay $203,776 to resolve allegations that they improperly obtained payments for ineligible expenses, including rental payment for CSWR offices in their personal residence.  USAO CO

Tagged in: Contract Non-Compliance, FCA Federal, Grant and Research Fraud,

October 20, 2021

South Carolina provider Colonial Family Practice, LLC, has agreed to pay $1.25 million to resolve claims that they submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary nuclear stress tests and Cystatin-C tests, the latter of which were routinely submitted as part of a panel run on most patients, despite being payable for only a narrow set of patients.  The settlements resolve two qui tam actions brought by a former clinical manager and by a former physician assistant.  USAO SC

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

October 20, 2021

MD Spine Solutions LLC, d/b/a MD Labs Inc., and its owners, co-founders Denis Grizelj and Matthew Rutledge, have agreed to pay up to $16 million to settle fraud allegations raised by an unnamed whistleblower.  MD Labs had allegedly billed Medicare, Medicaid, and other federal healthcare programs for presumptive urine drug testing as well as confirmatory urine drug testing run on the same samples, which is frequently baseless or useless.  USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

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