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March 13, 2020

Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, LLC, have agreed to pay $1.74 million to settle claims of submitting false and inflated claims to Medicare.  From 2011 to 2016, defendants billed and caused Medicare to pay for lower-level wound repairs as if they were more complex adjacent tissue transfers.  The misconduct was eventually exposed by whistleblowers Dr. Robert Green and Emily Kennedy, who will share in a $305,000 award.  USAO MDFL

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

March 11, 2020

Millennium Physicians Association PLLC, d/b/a Millennium Respiratory & Sleep Disorder Specialists, has agreed to pay $1.2 million to resolve whistleblower-brought allegations of fraud in connection with two sleep centers in Texas.  From 2015 to 2019, Millennium allegedly violated Medicare rules and the False Claims Act by improperly billing Medicare for sleep studies conducted without the presence of properly credentialed technicians.  As part of the settlement, the anonymous relator will receive a $187,344  share of the settlement.  USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicare, Whistleblower Case, Whistleblower Rewards,

March 11, 2020

The organizer of a $2 million multi-state Medicaid fraud scheme has been sentenced to 11 years in prison and ordered to pay $2.5 million in restitution.  Along with two other co-defendants, Matthew Harrell fraudulently obtained the Medicaid provider number of mental health service providers in Georgia and Florida, as well as the Medicaid member numbers of children in foster care, welfare, and other programs in Louisiana.  Using companies purporting to be mental health providers, the defendants then submitted $3.5 million in false claims and received $2.5 million in reimbursements. Harrell's co-defendants, Nikki Richardson and Tomeka Howard, have also been ordered to serve time and pay restitution.  USAO NDGA

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

March 2, 2020

The owners and operators of Middlesex Rheumatology in Connecticut, Dr. Crispin Abarientos and his wife Dr. Antonieta Abarientos, have agreed to pay $4.9 million to settle allegations of violating federal and state False Claims Act.  Between 2013 to 2017, the Abarientos allegedly billed Medicaid for an injectable prescription drug called Remicade, which is used to treat rheumatoid arthritis, but then failed to administer the drugs on Medicaid patients.  Instead, they administered them on patients covered by Medicare or the Connecticut State Employees Health Plan, then billed the two providers for the drugs again even though the cost had already been covered by Medicaid.  USAO CT

Tagged in: Criminal Proceedings, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

February 28, 2020

Nursing home chain Diversicare Health Services, Inc. has agreed to pay $9.5 million to resolve whistleblower-brought allegations of submitting claims to Medicare and Medicaid for medically unnecessary rehabilitation therapy services.  According to separate qui tam complaints by former employees, Mary Haggard and Bryant Fitzmorris, between 2010 to 2015, Diversicare unnecessarily placed beneficiaries in the highest category of reimbursement in order to receive higher payouts, and submitted forged pre-admission evaluation certifications to Medicaid.  As part of the settlement, Diversicare has entered into a Corporate Integrity Agreement for five years, Haggard will receive approximately $1.4 million, and Fitzmorris will receive approximately $145,450.  DOJ; USAO MDTN

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, SNF, Whistleblower Case, Whistleblower Rewards,

February 19, 2020

Guardian Elder Care Holdings, Inc. has agreed to pay $15.5 million to settle claims of defrauding Medicare and Medicaid.  In a qui tam suit filed in 2015, whistleblowers Philippa Krauss and Julie White alleged that from 2011 to 2017, the Pennsylvania-based nursing home chain pressured its therapists to provide medically unnecessary rehabilitation to patients suffering from dementia or dying in hospice care in order to boost its profits.  During the subsequent government investigation, Guardian Elder Care self-disclosed that it had also billed federal healthcare programs for services performed by two excluded individuals.  As part of the settlement, Guardian Elder Care has entered into a chain-wide Corporate Integrity Agreement with the Department of Health and Human Services, and Krauss and White will split a $2.8 million relator's share.  USAO EDPA; USAO WDPA

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

February 11, 2020

Tenet Healthcare Corporation and its affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.4 million to settle allegations that they knowingly charged Medicare for medically unnecessary cardiac monitors, in violation of the False Claims Act.  According to former DRMC employee, Michael Grace, the devices were implanted between 2014 to 2017, exposing beneficiaries to unnecessary risk and causing the government unnecessary expenses.  For exposing the fraud, Grace will receive a $240,789 share of the recovery.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

February 4, 2020

Psychotherapy, adolescent therapy, and tutoring company The Center of Attention, LLC: No One Left Behind, together with its owner Selina Christian, will pay $200,000 and be suspended from Connecticut's Medicaid program, based on allegations that defendants violated the Connecticut False Claims Act and submitted false claims for services that were either never provided, or that were for non-psychotherapy services that were not covered by Medicaid.  CT

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

February 4, 2020

Southeastern Retina Associates (SERA), which operates in parts of Tennessee, Georgia, and Virginia, has agreed to pay $1.5 million and enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services for allegedly defrauding Medicare and Medicaid.  The investigation was launched by a qui tam suit filed by an unnamed whistleblower, which alleged that between 2009 to 2016, the practice improperly billed exams at a higher rate than appropriate, and used a billing code called Modifier 25 to bill for exams that were not separately billable from other services billed the same day.  For exposing the misconduct, the relator in this case will receive a $270,000 share of the settlement.  USAO EDTN

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

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