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February 27, 2019

A Florida-based home health agency owner, Alexander Ros Lazo, has been sentenced to over 7 years in prison and ordered to pay $8.6 million in restitution for defrauding Medicare. In exchange for the referral of Medicare beneficiaries to his company, T.L.C. Health Services, Dos Lazo paid kickbacks to co-conspirators and caused his co-conspirators to submit billing for physical therapy services performed by an unlicensed practitioner, Misleady Ibarra. Along with Ros Lazo. Ibarra has been sentenced to 2 years in prison; the amount she will pay in restitution is still to be determined. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicare, Provider Fraud,

February 22, 2019

Marketers, doctors, lawyers, and medical service provider defendants were sentenced this week for their roles in a multi-million dollar California worker's compensation fraud scheme in the San Diego area.  The defendants recruited patients and referred them to co-defendant attorneys to file fraudulent claims on their behalf and medical providers who performed often unnecessary and painful medical procedures for which they would then bill insurers including California Workers' Compensation.  Ronald Grusd, a doctor who owned a diagnostic imaging company, was sentenced to 10 years in prison and ordered to forfeit $1.3 million.  Fermin Iglesias, who worked as a patient capper, was sentenced to 5 years in prison and ordered to forfeit $1 million. Julian Garcia, who provided services to assist the referrals and kickbacks, was sentenced to three years in prison.  Jennifer Louise White, who marketed to providers in the network, was sentenced to two years in prison.  Sean O'Keefe, an attorney who filed fraudulent claims on behalf of patients, was sentenced to 13 months in prison and ordered to forfeit $300,000.  Steven Rigler, a chiropractor, was sentenced to six months in prison.  USAO SD Cal.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

February 20, 2019

Hope Thomley of Hattiesburg, Mississippi, pleaded guilty for her role in a compounding pharmacy kickback scheme.  Thomley was the owner and operator of acompany that marketed for Advantage Pharmacy in Hattiesburg, and received 50% of Advantage's reimbursements.  Thomley admitted that she knew Advantage submitted false claims for payment to federal healthcare programs for medications that had not been prescribed by a doctor or were not medically necessary.  Between 2012 and 2016, health care benefit programs, including TRICARE, reimbursed Advantage Pharmacy and other pharmacies involved in the scheme at least $200 million. DOJ

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

February 12, 2019

Michael Frey of Ft. Myers, Florida, a physician specializing in pain management, was sentenced to 18 months in prison for his role in an illegal kickback scheme.  Frey was a co-owner of Advanced Pain Management Specialists, P.A., and received kickbacks from A&G Spinal Solutions, LLC (which made checks payable to his wife) for a share of its profits from patient referrals; from a compound pharmacy provider; and as "speaker fees" from Insys Therapeutics, a pain medication manufacturer.  Frey previously agreed to pay $2.8 million in civil settlement of claims under the False Claims Act.  USAO MD FL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Pharma Fraud, Provider Fraud,

February 8, 2019

A Texas-based marketing company, One Source Healthcare Organization, and its owner, James Paul Adams, have agreed to pay $339,412.50 to resolve allegations that it violated the Anti-Kickback Statute in accepting illegal payments from a compounding pharmacy to market their drug. Because the payments resulted in false claims being paid by Medicare and TRICARE, they were also alleged to be in violation of the federal False Claims Act. Two men affiliated with the compounding pharmacy, Oklahoma-based OK Compounding, LLC, were previously indicted on similar charges. USAO NDOK

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

February 6, 2019

An electronic health records provider, Greenway Health LLC, will pay $57.25 million to settle a False Claims Act case brought by the U.S. alleging that Greenway fraudulently obtained certification that is product, Prime Suite, complied with HHS requirements and therefore that healthcare providers using Prime Suite could receive payments under the Medicare and Medicaid EHR Incentive Program.  Greenway allegedly modified the software tested by the certification body to make it appear that Prime Suite was performing as required when it was not, and failed to correct known errors in the software.  In addition, the government alleged that Greenway violated the Anti-Kickback Statute by providing incentives including payments to clients to recommend Prime Suite. Greenway entered into a five-year Corporate Integrity Agreement which includes an independent monitoring process.  DOJ

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud,

February 6, 2019

Abbott Labs has agreed to pay a total of $25 million to settle allegations of paying kickbacks to healthcare professionals in exchange for promotion of its drug, and inappropriately marketing its drug, TriCor, for cardiovascular events not approved by the FDA. The case was initiated by the State of North Carolina and joined by California, Illinois, Nevada, Maryland, Michigan, and Texas, as well as the federal government. NC AG

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicaid, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud,

February 6, 2019

Georgia-based Union General Hospital has agreed to pay $5 million to settle allegations that from 2012 to 2016, it billed Medicare for services stemming from improper financial relationships with physicians, in violation of the Stark Law and the False Claims Act. The misconduct was uncovered during an internal investigation sparked by a federal investigation into an unrelated matter; UGH then voluntarily self-disclosed details of the instant case to the U.S. Attorney's Office. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicare,

January 30, 2019

Inform Diagnostics, formerly known as Miraca Life Sciences Inc., will pay $63.5 million to resolve allegations that it violated the False Claims Act, Anti-Kickback Statute and Stark Law.  The pathology laboratory company provided referring physicians with subsidies for electronic health records systems, as well as free or discounted technology consulting services, which were alleged to constitute improper financial relationships not subject to any safe harbor.  Three separate whistleblowers had filed qui tam lawsuits against the laboratory; they will receive a share of the settlement that is yet to be determined.  DOJ; USAO MDTN

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

January 29, 2019

Tennessee-based home dialysis provider WellBound of Memphis agreed to pay $3,246,000 to the State of Tennessee and the United States for allegedly submitting false claims to Medicare, TRICARE, and Tenncare from 2016 to 2018. According to a qui tam complaint filed by whistleblower Dr. Darryl Quarles, the claims resulted from illegal inducements for patient referrals, which violated the anti-kickback statute (AKS) and are not payable under state or federal laws. USAO WDTN

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

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