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February 3, 2020

Senthil Kumar Ramamurthy of Texas has been sentenced to 10 years in prison for participating in two fraud schemes that amounted to $9.6 million in losses by Medicare and TRICARE.  In the first scheme, which ran for 10 months in 2014, Ramamurthy and his co-conspirators were paid millions of dollars by compounding pharmacies to get TRICARE beneficiaries to sign up for medically unnecessary compounded prescription drugs.  To get beneficiaries to sign up, defendants had falsely represented that the drugs would be free, when in fact co-payments were required.  In the second scheme, which ran from 2015 onward, Ramamurthy and his co-conspirators paid doctors to refer Medicare beneficiaries—without first examining them—for needless genetic cancer screening tests.  Many of Ramamurthy's co-conspirators have plead guilty and face sentencing later this month.  USAO SDFL

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

January 29, 2020

A Florida-based physician, Erik Schabert, and his ex-wife, Mika Harris, have been sentenced to 3.5 years and 3 months in prison, and ordered to pay almost $4.5 million in restitution to Blue Cross Blue Shield for attempting to defraud the insurer and the Medicare program of more than $8 million.  Between 2013 and 2016, the two owners and operators of Reliant Family Practice falsely diagnosed actinic keratosis and rosacea in order to make fraudulent claims for chemical peels and dermabrasions.  Along with prison time and restitution, the two have forfeited their private residence, commercial property, and over $260,000 in an annuity account, to the federal government.  USAO NDFL

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare,

January 16, 2020

A former pharmaceutical sales representative in Texas has been sentenced to 2.5 years in prison and ordered to pay $1,746,222 in restitution for participating in a healthcare bribery scheme from 2013 to 2014.  In return for receiving commissions from pharmacies and paying them to medical providers, Holly Blakely had submitted fraudulent prescriptions to two different compounding pharmacies on behalf of unsuspecting individuals, causing approximately $8.8 million in losses to private and government healthcare providers.  USAO WDTX

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity,

January 15, 2020

TMJ & Orofacial Pain Treatment Centers of Wisconsin has agreed to pay $1 million to settle a qui tam suit alleging submissions of false claims to Medicare and TRICARE.  According to the anonymous whistleblower, who will receive an undisclosed share of the settlement, TMJ billed the government health programs for prosthetic devices as if they had been fabricated by in-house surgeons, when in fact they had been fabricated by an outside laboratory.  USAO EDWI

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs, Provider Fraud, Upcoding, Whistleblower Case,

January 10, 2020

The owner of two Philadelphia-based testing laboratories has pleaded guilty and agreed to pay more than $77 million in restitution for participating in an illegal kickback scheme.  At his plea hearing, Ravitej Reddy admitted that his laboratories, Personalized Genetics, LLC and Med Health Services Management, LP, participated in a fraudulent scheme that took advantage of the labs' location in a high reimbursement area for Medicare cancer and pharmacogenetic testing the labs actually sent for testing to a laboratory that was located outside of the lucrative coverage area, because the labs lacked equipment to perform the tests themselves.  To secure the lab orders, Reddy admitted paying kickbacks to co-conspirators, including marketers that solicited specimens from Medicare beneficiaries, and a telemedicine practice that improperly authorized the tests without regard to medical necessity.  In addition to the restitution order, Reddy faces a maximum of 25 years in prison at his sentencing in February.  USAO WDPA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

January 6, 2020

A now defunct behavioral health clinic, Tree of Life, Inc., and its owners and operators, Ada and Victor Vidal, have agreed to pay $1.65 million to settle a whistleblower's claims that they violated the False Claims Act and Anti-Kickback Statute in claims to Pennsylvania's Medicaid program.  According to Erika Desjardins, the former Clinical Director, Tree of Life billed for therapy sessions where either the patient or therapist could not possibly have attended (in some cases due to a patient’s hospitalization or death), as well as therapy sessions provided by unqualified individuals.  To facilitate the fraud scheme, it created fake records, including forged signatures, and improperly paid a social worker for patient referrals.  As part of the settlement, the Vidals have been excluded from future participation in federal healthcare programs, and Desjardins, who had been fired for reporting internally, will receive $330,000 as their share of the recovery.  USAO EDPA

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

January 2, 2020

Two physicians in the San Diego area have agreed to pay nearly $1 million to settle allegations that they violated the False Claims Act by improperly billing Medicare for care provided by an uncredentialed physician.  The fraudulent conduct by Drs. Mark Smith and Fane Robinson of San Diego Retina Associates was revealed in a qui tam lawsuit by fellow ophthalmologist and former partner, Dr. Atul Jain, who will receive $170,778 of the settlement proceeds.  USAO SDCA

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

December 30, 2019

A defense contractor accused of submitting false claims on a contract with the U.S. Army has agreed to pay $3 million to resolve its liability.  Kansas-based LaForge & Budd Construction Company, Inc., had been tasked with raising the elevation of a dam at the Fort Sill Army Post in Oklahoma.  Although the contract specified that satisfactory fill be used, LaForge defied this by using materials such as pieces of concrete, rebar, and rubble, and then represented to the Army that it had fully complied with the contract's terms and conditions.  USAO WDOK

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare,

December 30, 2019

Medsurant Holdings, LLC, the nation's largest independent provider of Interoperative Neuromonitoring (IONM) services, has agreed to pay $1.9 million to settle allegations of defrauding Medicare.  According to the DOJ, from 2013 to 2016, Medsurant billed Medicare for IONM services—used to monitor patients’ nervous systems during high-risk surgeries—that were not provided exclusively to one patient or were concurrently provided to patients insured by private payors, in violation of Medicare rules as well as the False Claims Act.  USAO MDTN

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

December 20, 2019

Florida residents and married couple Rodolfo Pichardo and Marta Pichardo were sentenced to 15 years and 8 years, respectively, following earlier guilty pleas to healthcare fraud and wire fraud.  Defendants were also ordered to pay over $34 million in restitution. The Pichardos ran a network of home health agencies, pharmacies, and therapy staffing companies, that submitted more than $38 million in false claims to Medicare.  Defendants paid kickbacks to patient recruiters and medical clinics for patient referrals.  USAO SD FL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medical Billing Fraud, Pharma Fraud,

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