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January 22, 2021

The estate of Dr. Patrick T. Hunter has agreed to pay more than $1.7 million to resolve allegations that the urologist, who passed away in 2019, submitted false claims to Medicare and TRICARE for medically unnecessary procedures and received improper payments for them from the Orlando Center for Outpatient Surgery.  Between 2010 and 2016, Dr. Hunter allegedly performed the lithotripsy procedures, which break up kidney stones, on patients who either did not have kidney stones or were not medically indicated for them.  For initiating the successful qui tam suit, whistleblower Scott Thompson will receive a relator’s share of $385,000.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

January 19, 2021

Texas-based Allstate Hospice LLC and Verge Home Care LLC and their founders, Onder Ari and Sedat Necipoglu, have paid over $1.8 million to resolve allegations of submitting claims to Medicare that were tainted by improper inducements.  In violation of the Physician Self-Referral Law and False Claims Act, the defendants allegedly set up monthly payments to referring physicians through sham medical directorship agreements, sold interests to five referring physicians in order to provide them with substantial quarterly dividends, and provided other referring physicians with free tickets and travel.  USAO SDTX

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

January 15, 2021

The co-owner of multiple compounding pharmacies and pharmaceutical distributors in Mississippi has been sentenced to 18 years in prison and ordered to pay over $287 million in restitution and over $56 million in forfeiture after pleading guilty to healthcare fraud and money laundering.  As part of his guilty plea, Wade Ashley Walters admitted to being the mastermind behind a four-year scheme that defrauded TRICARE and private health benefit programs of over $287 million.  To perpetuate the fraud, Walters and his co-conspirators solicited and paid recruiters to procure prescriptions for highly reimbursed compounded medications, solicited and paid physicians to authorize prescriptions for same, adjusted prescription formulas to ensure the highest reimbursement possible, and improperly waived or reduced mandatory beneficiary copayments.  USAO SDMS

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Criminal Proceedings, FCA Federal, Healthcare Fraud, Other Government Health Programs,

January 6, 2021

Exceltox, a genetic testing laboratory in California, has agreed to pay $357,584 to resolve allegations of submitting false claims to Medicare over two months in 2015.  With the help of a New Jersey-based contractor named Seth Rehfuss, Exceltox allegedly performed genetic tests on seniors in New Jersey-based senior housing complexes without proper orders from a treating physician, then submitted claims to Medicare for these tests.  For his role in the fraud, Rehfuss was sentenced to over 4 years in prison in 2019.  USAO NJ

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare,

January 4, 2021

Three providers, James P. Anderson, as owner of Affiliated Neurologists, PLC; Charles F. Spencer, as owner of Total Family Physicians Center PLLC; and Mitchell P. Shea, as owner of Chiro2Med of Tennessee P.C., have agreed to pay the United States and Tennessee a total of $1.72 million to resolve allegations under the False Claims Act for improperly billing Medicare and TennCare for “P-Stim” electro-acupuncture devices that do not qualify for reimbursement.  The defendants billed for the disposable P-Stim devices using a code reserved for neurostimulator devices that are implanted during a surgical procedure. USAO MDTN

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

December 31, 2020

Department of Veterans Affairs contractor TriWest Healthcare Alliance Corp. has agreed to pay $179.7 million to resolve allegations that it improperly retained overpayments received from the VA.  TriWest administered portions of VA’s former Veterans Choice Program and its Patient-Centered Community Care Program (PC3), which enable veterans to obtain VA-paid healthcare from private providers.  At times, VA allegedly paid TriWest twice for the same services, or paid for services for which TriWest received full or partial reimbursement from other healthcare providers, and TriWest failed to return those overpayments.  DOJ

Tagged in: FCA Federal, Government Procurement Fraud, Healthcare Fraud, Other Government Health Programs,

December 21, 2020

DME provider Apria Healthcare Group, Inc. and Apria Healthcare LLC will pay $40.5 million to settle allegations brought in a qui tam action filed by three former Apria employees that they improperly billed government healthcare programs for beneficiary rentals of non-invasive ventilators (“NIVs”) that were not medically necessary or which were provided with improper waivers of patient co-payments.  Medicare pays as much as $1,400 a month for NIVs, and providers are required to monitor patient usage of NIVs and stop billing when the NIVs are no longer being used.  Apria respiratory therapists failed to monitor patient NIV usage and even when Apria knew that patients were no longer using the NIVs, Apria often did not take steps to stop seeking payment.  In addition, Apria sales staff steered doctors and beneficiaries to use NIVs when less-expensive alternatives were available, and routinely waived co-payments for NIV patients without making an assessment of the patient’s financial need.  USAO SDNY; CA AG; FL AG

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case,

December 21, 2020

Substance abuse treatment provider A.R.E.B.A.-CASRIEL, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (“ACI”) and its owner, Steven Yohay, agreed to pay a total of $6 million to resolve federal and New York state claims that they defrauded Medicaid including through the payment of kickbacks and other fraudulent conduct in connection with the enrollment of Medicaid beneficiaries into ACI’s inpatient treatment program.  Defendants allegedly employed drivers who were compensated in part based on the number of patients they recruited, to target homeless individuals to enroll in ACI’s inpatient treatment program by offering food, cash, and money to purchase drugs, and/or alcohol. In addition, ACI unlawfully paid a patient recruiter, and enrolled Medicaid patients who had not been evaluated by a qualified healthcare professional, including by copying a physician’s signature.  The government’s investigation was initiated by a whistleblower complaint filed by a former employee, who will receive an undisclosed amount of the settlement.  USAO SDNY; NY

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 4, 2020

Joint Active Systems, Inc. (JAS), a durable medical equipment manufacturer, and New England Orthotics & Prosthetics, LLP (NEOPS) have agreed to pay $1.59 million and $90,000 respectively to resolve allegations of defrauding multiple federal healthcare programs—including TRICARE, Medicare, and Medicaid programs in Connecticut, Massachusetts, and Rhode Island—through a variety of fraudulent schemes.  According to a qui tam suit filed by two former NEOPS employees, JAS allegedly recruited NEOPS to bill Medicare and Medicaid for custom-fabricated orthotics that were not custom-fabricated orthotics, nor medically necessary, and falsely claim that JAS-affiliated sales representatives were properly trained to treat patients during fittings.  Additionally, JAS allegedly overcharged the VA for its devices by as much as 300%.  For blowing the whistle on these fraud schemes, the whistleblowers will receive a 17% share of the settlement proceeds.  USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medical Devices and DME, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

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