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December 2, 2020

The owner and operator of Atlanta-based Elite Homecare has been sentenced to over five years in prison and ordered to pay $999,999 in restitution for defrauding Medicaid of nearly $1 million. As a provider under the Georgia Pediatric Program (GAPP)—an in-home nursing program for Medicaid-eligible children with severe physical and cognitive disabilities—Diandra Bankhead allegedly submitted thousands of claims for services that were fraudulent in a myriad of ways. Some of the claims falsely represented that employees provided more than 24 hours of services in a given day to multiple children simultaneously (including to children whose families had not retained Elite, and by RNs who did not know their credentials were being used), while other claims contained fraudulent credentialing information and fraudulent supporting documentation, or were upcoded to induce higher payments from Medicaid. Additionally, Bankhead allegedly “sold” information about twenty of Elite’s former clients to another Atlanta-based home health provider in exchange for a percentage of the reimbursements from Medicaid. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud, Provider Fraud, Upcoding,

November 24, 2020

Florida-based Doctor’s Choice Home Care, Inc. and its founders and former top executives Timothy Beach and Stuart Christensen have agreed to pay a combined $5.15 million to settle qui tam suits filed under the False Claims Act by former employees—one by Corina Herbold, and the other by Sara Billings, Misty Sykes, and Marina Eschoyez-Quiroga. In violation of the Anti-Kickback Statute and the Stark Law, the home health agency had allegedly set up sham medical director agreements with physicians to pay them for referrals, linked employee bonuses to referrals made by physician spouses, and provided medically unnecessary services to Medicare patients in order to avoid decreased reimbursements triggered by fewer than five skilled service visits. To settle the allegations, Doctor’s Choice will pay over $4.5 million, while Beach and Christensen will pay $647,000 each. Billings, Sykes, and Eschoyez-Quiroga will jointly receive $145,000 of the settlement proceeds; Herbold’s share has yet to be determined. DOJ; USAO MDFL

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

November 20, 2020

Mori, Bean and Brookes, P.A. (MBB), a Florida-based radiology practice, has agreed to pay $1.4 million to resolve allegations of violating the False Claims Act. In a qui tam suit by Thomas Heyck, a radiologist formerly employed at MBB, the practice improperly billed Medicare and Medicaid for radiological images that were interpreted outside the U.S., which are not eligible for reimbursement. MBB also submitted claims for images that were initially interpreted overseas, then reinterpreted and billed to a domestic radiologist. For blowing the whistle, Heyck will receive a 19% relator’s share. USAO MDFL

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

November 19, 2020

Johnson & Johnson (J&J) subsidiary Medical Device Business Services, Inc. (MDBS) has agreed to pay $10 million to settle allegations that a former J&J subsidiary, Therakos, Inc., promoted two medical devices for unapproved uses in pediatric patients. A second entity, The Gores Group (TGG), agreed to pay $1.5 million to settle allegations of continuing to promote the devices for unapproved uses after it acquired Therakos in 2012. In an action initiated by a whistleblower, the government alleged that between 2006 and 2015, Therakos improperly promoted its extracorporeal photopheresis (ECP) systems, used to treat cutaneous T-cell lymphoma, for use in children despite the fact that no ECP devices had been approved for that population. In so doing, Therakos allegedly caused false claims to be submitted to Medicaid, the Federal Employee Health Benefits Program, and TRICARE, in violation of the False Claims Act. The total settlement funds were divided between federal and state governments. USAO EDPA; CA

Tagged in: FCA Federal, Medicaid, Medical Devices and DME, Off-Label and Unapproved Use, Other Government Health Programs, Whistleblower Case,

November 16, 2020

Seattle’s Group Health Cooperative, now part of Kaiser, will pay $6.375 million to settle allegations in a whistleblower suit that it falsely reported unsupported diagnosis codes to Medicare in order to receive inflated payments. The suit alleges that GHC utilized the services of a coding review company, DxID, that proposed unsupported diagnosis codes, which GHC knowingly submitted to CMS as part of seeking higher payment for the affected Medicare Advantage beneficiaries. Whistleblower Teresa Ross, represented by Constantine Cannon, will receive approximately $1.5 million. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Medical Billing Fraud, Medicare, Risk Adjustment Fraud, Whistleblower Case, Whistleblower Rewards,

November 2, 2020

Hospital system Memorial Health Services will pay a total of $31.5 million after self-disclosing that it overcharged California’s Medicaid program, Medi-Cal, for outpatient prescription drug reimbursements under the 340B Drug Pricing Program. Memorial Health billed Medi-Cal for outpatient drugs at its usual and customary rate, rather than the lower “actual acquisition costs,” as required under the 340B Drug Pricing Program. California will receive $18.9 million of the settlement, and the federal government will receive $12.6 million. Cal; CD Cal

Tagged in: Drug and DME Pricing, Hospital Fraud, Medicaid, Pharma Fraud,

October 29, 2020

Medtronic has agreed to pay over $9.2 million to resolve allegations of violating the False Claims Act and CMS’s Open Payments Program by paying kickbacks to a South Dakota-based neurosurgeon, Wilson Asfora, M.D., in order to induce sales of its SynchroMed II implantable intrathecal infusion pumps. According to the government, Medtronic allegedly sponsored nine years’ worth of events at a restaurant owned by Asfora, and to which Asfora would invite his acquaintances, business partners, trusted colleagues, and referral sources. For his role in the kickback scheme, Asfora has been named in a separate FCA lawsuit, which the United States joined last November. USAO SD

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare,

October 22, 2020

Jerry Taylor of North Carolina has been sentenced to five years in prison and ordered to pay more than $6.1 million in restitution for his role in a $9.4 million fraud scheme targeting North Carolina’s Medicaid program. Along with his brother Tony and co-conspirators in Ohio and New York, Taylor submitted claims for behavioral health services benefiting local at-risk youth that were purportedly performed at companies he owned and operated with his brother, but that were in reality not actually performed or misrepresented in the claims. In addition to defrauding Medicaid, Taylor also evaded taxes by failing to report more than $1.6 million in reimbursements in 2016 and 2017. For those charges, Taylor will pay over $346,000 to the IRS. USAO WDNC

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

October 16, 2020

Massachusetts home health agency Altranais Home Care, LLC and its owners, Constant Ogutt and Shakira Lubega, will pay $3.1 million to resolved claims that they submitted false claims to the state’s Medicaid program, MassHealth. According to the state, the defendants billed for services for which they did not have a physician-authorized plan of care. Mass

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

October 2, 2020

Two New York-based physical therapy providers have agreed to pay $4 million to resolve whistleblower-brought allegations of violating the False Claims Act by improperly billing multiple government healthcare programs, including Medicare, Medicaid, the Federal Employees’ Compensation Act Program (FECA), and the Federal Employees’ Health Benefits Program (FEHBP). The alleged misconduct by Williamsburg Physical Therapy, P.C., Euro Physical Therapy, P.C., owners Alex and Diana Klurfeld, and management company First Plus Services, Inc. occurred between 2008 to 2018, and involved billing for physical therapy services provided or supervised by someone other than the licensed therapist listed on claims, as well as backdating services after treatment authorizations had expired. USAO EDNY

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Whistleblower Case,

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