Archive

January 21, 2016

New York will receive $47 million in a settlement with CenterLight Healthcare and CenterLight Health System, resolving allegations that CenterLight Healthcare’s Select Medicaid Managed Long Term Care Plan fraudulently billed Medicaid for services they did not provide to more than 1,200 Medicaid recipients. Under the settlement, CenterLight Healthcare admitted that it enrolled Medicaid beneficiaries who were referred by social adult day care centers even though the beneficiaries were not eligible to receive managed long-term care under the plan, and that the centers were providing services that did not qualify for reimbursement under New York State Department of Health standards, or CenterLight’s contract with DOH.  Whistleblower David Heisler will receive a yet-to-be-determined whistleblower award. NY

October 21, 2015

United Parcel Service has agreed to pay $4 million to resolve allegations that the company violated the false claims acts of 14 states, New York City, Washington D.C., and Chicago.  Under contracts at issue between UPS and the government, UPS guaranteed delivery of packages by certain specified times the following day. The investigation began after a UPS employee filed a federal whistleblower lawsuit in Virginia alleging that a practice of falsifying package arrival times and logging in phony reasons for late arrivals went on company-wide. The UPS employee alleged that, in some cases, bogus exception codes excusing late deliveries were entered into the tracking system before UPS drivers had even arrived at locations where cumbersome security procedures and other delays had purportedly occurred. The state settlement follows an earlier $25 million settlement with the federal government.  NJ; NY

September 23, 2015

The Florida Attorney General announced a $3.5 million settlement with Adventist Health System Sunbelt Healthcare Corporation and Adventist Health System/Sunbelt, Inc. to resolve two suits brought by whistleblowers alleging that Adventist maintained improper financial relationships with physicians and submitted claims to Florida Medicaid for services and items the physicians referred. The settlement resolves claims that Adventist submitted false Medicaid claims and awarded referring doctors based on the number of tests and procedures the doctors ordered. Adventist also entered into separate civil settlements with the federal government, North Carolina and Texas, agreeing to pay more than $115 million. FL.

August 24, 2015

The New York Attorney General announced settlement agreements with five defendants in a False Claims Act case that will return more than $8 million to the Medicaid and Medicare programs. The agreements resolve claims that SpecialCare Hospital Management Corporation defrauded Medicaid and Medicare by illegally referring patients to unlicensed drug and alcohol treatment programs in exchange for kickbacks. Investigation of the defendants began after whistleblowers Mathew I. Gelfand, M.D. and Enrico Montaperto filed complaints under New York’s False Claims Act. NY

June 29, 2015

New York announced a settlement with pharmacy Trinity Homecare LLC that returns $2.5 million to the state’s Medicaid program. A whistleblower filed a lawsuit in 2009 alleging that Trinity pushed infusion drugs, which are prescribed to manage symptoms, to hemophilia patients and presented claims to Medicaid for unneeded or excessive quantity of these drugs. The whistleblower alleged improper billing for drug deliveries, including ones that patients refused to accept and excess shipments. In at least one instance, these expensive drugs were allegedly left outside a patient’s home without signature by the patient. NY

June 18, 2015

47 states and the District of Columbia reached a settlement with Inspire Pharmaceuticals, resolving allegations that Inspire violated state and federal False Claims Act laws by illegally marketing the drug Azasite for off-label uses not approved by the U.S. Food and Drug Administration. Approved only for the treatment of bacterial conjunctivitis (“pink eye”), Inspire marketed Azasite for the treatment of blepharitis, an inflammation of the eyelash follicles. While physicians are permitted to prescribe drugs for conditions other than those for which the drugs have been approved by the FDA, pharmaceutical companies are prohibited from marketing drugs to physicians for such off label conditions. It is contended that, as a result of Inspire’s illegal off label promotion, Inspire caused the submission of false and fraudulent claims for Azasite to the Medicaid program and other federal programs. NY

June 18, 2015

Connecticut commenced a case under that state’s False Claims Act against the co-owners of a psychiatric clinic alleged to have submitted false claims to the state’s Medicaid program, Connecticut Medical Assistance Program (CMAP), from January 2010 through December 2014. According to the complaint, the defendants illegally submitted false claims for reimbursement while knowingly retaining and concealing the overpayment. The psychiatrist is alleged to have engaged in a systemic practice of knowingly “upcoding” the claims for reimbursement she submitted to the CMAP. For example, as the complaint alleges, she routinely double, triple, and in some cases quadruple-booked appointments for her Medicaid patients, then submitted CMAP using a reimbursement code, which required her to see the patient for approximately 75 to 80 minutes when, in fact, she saw each patient for as little as 5-10 minutes. The state’s complaint identifies 113 days where the psychaitrist billed the CMAP for more than 24 hours of service. Both defendants are also alleged to have attempted to conceal from state auditors the existence of databases that contained information which would have established evidence that the claims were false. CT

June 11, 2015

Louisiana announced that its Medicaid program will receive over $5 million as a result of a settlement between specialty pharmacy company Accredo Health Group, Inc. and 40 states and the federal government, resolving allegations that Accredo engaged in a scheme with drugmaker Novartis to boost sales of the drug Exjade, which is used to treat chronic iron overload due to blood transfusions. Accredo is accused of improperly directing nurses to contact Medicaid beneficiaries to encourage continued use of Exjade. Accredo’s goal in the scheme was to earn higher sales revenue, additional dispensing fees and more rebates from Novartis. The nurses were directed to discuss Exjade’s common side effects, but not its less common but more severe possible side effects such as kidney or liver problems. LA

May 8, 2015

New York Attorney General Eric T. Schneiderman announced an agreement in principle to settle kickback claims against Medco Health Solutions subsidiary Accredo Health Group, Inc. to resolve allegations that Accredo recommended the drug Exjade to Medicaid patients in exchange for kickbacks from Novartis Pharmaceuticals Corporation which markets the drug. Under the settlement, Accredo will pay $60 million to the federal government, New York, and several other states. About $3.4 million of the settlement will resolve claims relating to New York’s Medicaid program. In January 2014, another pharmacy, BioScrip, Inc., agreed to pay $15 million to resolve similar claims. The case against Novartis is ongoing. NY

April 28, 2015

Life Focus Center of Charlestown, Inc., a former nonprofit that provided day habilitation services to individuals with developmental disabilities, agreed to pay more than $94,000 to settle claims it violated the Massachusetts False Claims Act by billing the state’s Medicaid program (MassHealth) for services not provided. MA