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December 8, 2021

Pharmacist Riad “Ray” Zahr and two pharmacies he owned and operated, Plymouth Towne Care Pharmacy Inc. and Shaska Pharmacy LLC will pay $1 million to resolve a lawsuit initiated by a whistleblower alleging that the pharmacies submitted false claims for Evzio, a naloxone hydrochloride product used for the rapid reversal of an opioid overdose.  The government alleged that the claims included false and misleading prior authorization requests, including forged physician authorizations.  In addition, defendants dispensed Evzio without collecting or attempting to collect co-payments. DOJ; USAO MA

Tagged in: Drug and DME Pricing, FCA Federal, Lack of Medical Necessity, Pharma Fraud, Whistleblower Case,

December 7, 2021

Vyera Pharmaceuticals, LLC and its parent company Phoenixus AG will pay up to $40 million and have agreed to make its drug Daraprim available to any potential generic competitor at list price to resolve claims of anticompetitive conduct.  The federal government and state governments alleged that Vyera principals Martin Shkreli and Kevin Mulleady enacted a plan to acquire life-saving toxoplasmosis drug, Daraprim, and dramatically raise its list price by 400% while engaging in conduct to prevent generic competition and protect their monopolistic pricing.  The resolution also bars Mulleady from working in the pharmaceutical industry for seven years; claims against Shkreli are continuing.  FTC; CA; NY; NC; VA

Tagged in: Drug and DME Pricing, Pharma Fraud,

December 7, 2021

New Jersey-based Princeton Pathology Services P.A. will pay $2.4 million to resolve allegations that it overbilled Medicare by submitting claims using a Current Procedural Terminology (CPT) code that required written analysis by a pathologist, when no such analysis was required or had been prepared.  A whistleblower, Jayant Barai, M.D., initiated the matter by filing a qui tam complaint under the False Claims Act, and will receive an award of $456,000.  USAO NJ

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

December 6, 2021

Pharmacy benefit manager Centene Corp. will pay $27.6 million to the State of Kansas to resolve allegations that it failed to satisfy its obligation to represent the state’s best interests in negotiations with companies that supply drugs to the state Medicaid program, failed to accurately report discounts it received from CVS-Caremark on certain retail pharmacy claims, and artificially inflated dispensing-fee amounts reported to state regulators.  The state alleged that Centene used an opaque reporting system that made it difficult for the state to determine the nature and appropriateness of certain pharmacy transactions.  As part of the settlement, Centene also agreed to change certain business practices to ensure greater transparency.  KS

Tagged in: Drug and DME Pricing, FCA State, Healthcare Fraud, Pharma Fraud,

December 2, 2021

Texas-based Flower Mound Hospital Partners LLC has agreed to pay $18 million and enter into a five-year Corporate Integrity Agreement to resolve fraud allegations.  According to Leslie Jennings, M.D., one of many physician-owners, when Flower Mound repurchased shares from physician-owners nearing retirement age and resold them to younger physicians, the company allegedly improperly took into account the value of each physician’s referrals in selecting to whom and how many shares would be resold.  Claims arising from these referrals were then knowingly submitted to Medicare, Medicaid, and TRICARE, in violation of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act.  For initiating a lawsuit that resulted in a successful enforcement action, Jennings will receive a $3 million share of the settlement.  DOJ

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

December 1, 2021

A collection of hospices known as Crossroads Hospice has agreed to pay $5.5 million to settle allegations raised in two qui tam suits by former employees Leanne Malone, Jackie Burns, and Angela Heck, and a home health physician in Tennessee, Dr. David Weber.  In their lawsuits, the whistleblowers alleged that between 2012 and 2014, Crossroads billed Medicare for hospice care for patients who were not terminally ill, including patients with Alzheimer’s or dementia.  Malone, Burns, and Heck will divide a million-dollar relator’s share.  USAO WDTN

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

November 23, 2021

A number of related entities operating in Ohio and Tennessee as Crossroads Hospice have agreed to pay $5.5 million to resolve allegations that they submitted false claims for hospice services that were not covered by Medicare.  Specifically, the government alleged that over a period of three years, Crossroads submitted claims for dementia or Alzheimer’s patients who were not terminally ill for at least a portion of the more than three years that the patients received care.  Two qui tam actions were filed regarding the false claims; the three individuals who jointly filed the first action, Leanne Malone, Jackie Burns and Angela Heck, were previously employees of Crossroads, and will receive approximately $1.045 million.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

November 22, 2021

Home health provider PruittHealth, Inc. has agreed to pay $4.2 million to resolve allegations that they knowingly submitted false claims for services that were not eligible for reimbursement because, among other things, they did not have the required face-to-face certifications or plans of care, and they did not document the beneficiary’s homebound status or need for the home health services.  Tina Peery, who initiated the government action by filing a qui tam complaint, will receive an award of $700,000.  USAO ND Ga

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

November 22, 2021

South Carolina chiropractor Daniel McCollum has consented to judgment of $9 million to resolve charges that he submitted false claims to federal healthcare programs in violation of the Anti-Kickback Statute and Stark Law.  McCollum admitted that his laboratory, Labsource (which was a party to a related action), gave referring providers an opportunity to earn revenue generated from their commercially-insured referrals for urine drug testing as an inducement for those providers to refer all of their federally-insured urine drug testing patients to Labsource.  McCollum also caused medically unnecessary prescriptions for pain creams often without the knowledge or approval of the patients’ healthcare providers.  In addition to the civil settlement, McCollum pleaded guilty to criminal kickback and healthcare fraud charges and will be sentenced at a later date.  DOJ; USAO SC

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

November 9, 2021

Numerous anesthesia providers and outpatient surgery centers in Georgia, including Ambulatory Anesthesia of Atlanta, LLC and Northside Anesthesiology Consultants, LLC, have agreed to pay over $28 million to resolve kickback allegations by whistleblowers Kathleen Hartney-Velazco, M.D., Jan Kersey, and Capitol Anesthesiology, P.C., who will receive a $4.7 million cut of the settlement.  According to the whistleblowers, the anesthesia providers made payments and provided free staffing to the outpatient surgery centers in order to obtain exclusivity contracts over a ten-year period.  USAO NDGA

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

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