Archive

January 27, 2016

New York announced that it reached an agreement with a Capital Region transportation company, Advantage Transit Group, Inc., for repayment of Medicaid funds totaling over $1 million dollars that the company was not entitled to receive. Advantage Transit Group provides, among other services, transportation for Medicaid recipients to and from appointments and submits claims for reimbursement to Medicaid. Under the settlement agreement, Advantage Transit Group acknowledged that it submitted claims for reimbursement to Medicaid for transportation services and received payment for services that were not rendered. NY

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

January 12, 2016

Connecticut-based J&L Medical Services agreed to pay $600,000 to resolve allegations it violated the federal and state False Claims Acts. J&L Medical is a durable medical equipment company that provides Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) devices and accessories to Medicare and Medicaid beneficiaries who have been diagnosed with obstructive sleep apnea. According to the government, the company regularly used the services of unlicensed technicians to provide respiratory therapy services to Medicare and Medicaid beneficiaries, including setting up CPAP and BiPAP machines, fitting the patients with the masks used with those machines, and educating the patients about the use of the machines. The allegations originated in a whistleblower lawsuit filed by John Hart, a former employee of J&L Medical and a licensed respiratory therapist, under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $102,000 from the proceeds of the government’s recovery. DOJ (CT)

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Medicaid, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

January 5, 2016

Nashville Pharmacy Services, LLC, and its majority owner Kevin Hartman, agreed to pay up to $7.8 million to settle charges they violated the False Claims Act by overbilling Medicare and TennCare for pharmacy services. Specifically, the government claimed the Nashville-based pharmacy that specializes in dispensing HIV and AIDS-related medications automatically refilled medications without a request from the beneficiary or their physician; improperly waived TennCare and Medicare co-payments without an individualized assessment of ability to pay; improperly used pharmaceutical manufacturers’ co-payment cards to pay the co-payments of Medicare beneficiaries; billed for medications dispensed after the deaths of certain beneficiaries; and billed for medications that lacked a valid prescription. The allegations originated in a whistleblower lawsuit filed by Marsha McCullough, a former Nashville Pharmacy order entry technician, under the qui tamprovisions of the False Claims Act. She will receive a whistleblower award of 18 percent of the government’s recovery which could amount to $1.4 million. Whistleblower Insider

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

December 16, 2015

Qualitest Pharmaceuticals, the company’s corporate shell, Vintage Pharmaceuticals, its parent Endo Pharmaceuticals, and seven of their affiliates, agreed to pay $39 million to 48 states and the federal government to settle charges they violated federal and state False Claims Acts by selling understrength chewable fluoride tablets. As part of the settlement, Qualitest admitted the drug labeling for its chewable fluoride tablets represented fluoride amounts in line with guidelines of the American Dental Association and the American Academy of Pediatrics when in reality it used less than half of these represented amounts. The allegations were first raised in a whistleblower lawsuit brought Dr. Stephan Porter under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of roughly $4.71 million from the proceeds of the government’s recovery. Whistleblower Insider, NY, NH

Tagged in: Defective Products, Drug Switching, FCA Federal, FCA State, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

November 18, 2015

Deaconess Home Health, Inc. (formerly known as Outreach Home Health) and its owner, Lazarus Bonilla, agreed to pay $3,724,000 to resolve charges they violated the False Claims Act through the false billing of personal care worker services to the Wisconsin Medicaid Program. Specifically, the defendants (1) intentionally recruited patients for personal care services without regards to whether the services were medically necessary; (2) instructed nurses employed by Deaconess to routinely inflate, without regard to medical necessity, the assessment of the patient that was provided to the Medicaid program; (3) failed to conduct required supervisory visits to ensure that services were in fact being provided, that services continued to be medically necessary, and that any services provided were appropriate for the needs of the patient; and (4) hired physicians to act as medical directors to sign plans of care for patients on whom they had not completed a physical examination. The allegations first arose in three whistleblower lawsuits filed under the qui tam provisions of the False Claims Act. Two of the whistleblowers are former employees of Deaconess. The whistleblowers collectively will receive a whistleblower award of approximately $600,000. (DOJ (EDWI)

Tagged in: FCA Federal, FCA State, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

November 16, 2015

Pittsburgh-based for-profit education company Education Management Corp. agreed to pay $95.5 million to resolves allegations it violated the federal False Claims Act and several state False Claims Acts by falsely certifying it was in compliance with Title IV of the Higher Education Act and parallel state statutes. The government alleged the company violated the statute’s Incentive Compensation Ban by running a high pressure boiler room where admissions personnel were paid based purely on the number of students they enrolled. The allegations first arose in series of whistleblower lawsuits filed under the qui tam provisions of the False Claims Act. The whistleblowers will collectively receive a whistleblower award of $11.3 million from the proceeds of the government’s recovery. Whistleblower Insider IN , IL , IA , MT , NJ , NY , NM , VA , WA

Tagged in: Education Fraud, FCA Federal, FCA State, Whistleblower Case, Whistleblower Rewards,

November 4, 2015

AstraZeneca LP and Cephalon, Inc. agreed to pay $54 million to settle government charges they violated federal and state False Claims Acts by overcharging state Medicaid programs for their pharmaceutical products. AstraZeneca will pay $46.5 million and Cephalon, the wholly-owned subsidiary of Teva Pharmaceutical Industries. Ltd., will pay $7.5 million. According to the government, the two pharmaceutical companies underpaid drug rebates owed the states under the Medicaid Drug Rebate Program, which requires drug makers to periodically return to the government a portion of their Medicaid proceeds. The allegations first arose in a whistleblower lawsuit filed by Virginia pharmacist and attorney Ronald Streck under the quit tam provisions of the Federal False Claims Act, New York False Claims Act and other state false claims statutes. Mr. Streck will receive a yet-to-be-disclosed whistleblower award from a portion of the government’s recoveries. Whistleblower Insider

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

September 4, 2015

Columbus Regional Healthcare System and Dr. Andrew Pippas agreed to pay more than $25 million to resolve allegations they violated the False Claims Act by submitting claims in violation of the Stark Law. The settlement also resolves allegations that Columbus Regional and Pippas submitted claims for payment to federal health care programs that misrepresented the level of services they provided. According to the government, between 2003 and 2013, Columbus Regional provided excessive salary and directorship payments to Pippas that violated the Stark Law. The government further alleged Columbus Regional submitted claims to federal health care programs for services at higher levels than supported by the documentation. The allegations first arose in two whistleblower lawsuits filed former Columbus Regional executive Richard Barker under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act. Barker will receive a yet-to-be-determined whistleblower award. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

June 15, 2015

Children’s Hospital, Children’s National Medical Center Inc. and its affiliated entities agreed to pay $12.9 million to resolve allegations they violated the False Claims Act by submitting false cost reports and other applications to the components and contractors of the Department of Health and Human Services, as well as to Virginia and District of Columbia Medicaid programs. The allegations first arose in a whistleblower lawsuit filed by former Children’s National Medical Center employee James A. Roark Sr. under the qui tam provisions of the False Claims Act. Mr. Roark will receive a whistleblower award of $1,890,649.98. DOJ

Tagged in: FCA Federal, FCA State, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme. Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit. Clearview is now owned by Community Health Systems which purchased HMA in January 2014. According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute. As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act. The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $119,031. DOJ, GA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

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