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January 28, 2019

Avanti Hospitals LLC and six of its owners will pay $8.1 million to settle claims that they violated the False Claims Act by submitting, or causing Avanti’s subsidiary, Memorial Hospital of Gardena, to submit false claims to the Medicare and Medicaid programs for medical services referred by a physician who received kickbacks and other improper payments from Gardena and other Avanti affiliates. The settlement partially resolves allegations originally brought in a whistleblower lawsuit filed by Dr. Joshua Luke, the former C.E.O. of Gardena Hospital. DOJ

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

January 28, 2019

Norma Zayas, of Miami, was sentenced to 51 months in prison for her role in a $4.66 million health care fraud scheme involving several Miami-area home health agencies, including Sunshine Home Health Services Inc., Empire Home Health Agency Inc., Mildred & Marce Home Health Care Services Inc., and Nursing Care PRN Inc., which purported to provide home health services to Medicare patients. Zayas must also pay $4,658,241.00 in restitution and forfeit $186,650.50. Zayas admitted that from approximately January 2010 through approximately January 2014, she operated Sunshine, Empire, and Mildred & Marce Home Health and paid kickbacks to patient recruiters in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services. She also paid kickbacks to patient recruiters who referred Medicare beneficiaries to Nursing Care PRN. As a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of nearly $4.66 million. DOJ

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

January 28, 2019

A skilled nursing facility based in Orlando, Florida, Conway Lakes NC, LLC, and related entities and physicians, have agreed to pay $1.5 million to resolve allegations that they engaged in a unlawful kickback and referral scheme for Medicare and TRICARE beneficiaries.  Conway Lakes was alleged to have contracted with orthopedic surgeon Kenneth Krumins under a sham “medical director” arrangement in violation of the Stark Law and Anti-Kickback Statute to induce him to refer patients for rehabilitation services.  A former employee of Conway Lakes, Jonathan Montes de Oca, reported the arrangement by filing a qui tam case under the False Claims Act and will receive $267,000 of the proceeds.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

December 21, 2018

The United States has partially intervened in a False Claims Act case initiated by a whistleblower against Wheeling Hospital Inc. along with Wheeling's management consultant R & V Associates Ltd., and Wheeling's CEO, Ronald Violi.  The defendants are alleged to have violated the Stark Law and Anti-Kickback Statute including through its payments to physicians based on referrals by those physicians and/or in excess of fair market value.  The whistleblower, Louis Longo, was previously Wheeling's executive vice president.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Hospital Fraud, Whistleblower Case,

December 20, 2018

Pain specialist Dr. Jonathan Daitch, a principal in Ft. Myers-based Advanced Pain Management Specialists, P.A., has agreed to pay more than $1.7 million to resolve allegations that he violated the False Claims Act.  Dr. Daitch caused Medicare and Tricare to be billed for medically-unnecessary urine drug testing performed at Advanced Pain's in-house laboratory.  In addition, Daitch received kickbacks for anesthesia services.  A co-owner of Advanced Pain, Dr. Michael Frey, previously agreed to pay $2.8 million to settle similar claims.  USAO MD Fla

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

December 19, 2018

Molecular Testing Labs, based in Vancouver, Washington, has agreed to settle claims that it violated the False Claims Act by paying local laboratories in exchange for referrals, in violation of the Anti-Kickback Statute.  The amount of the settlement will be determined in ongoing litigation between Molecular Testing Labs and CMS, and could be between $180,000 and $1,777,738. USAO WDWA

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

December 18, 2018

Following an earlier settlement of federal claims, Florida has announced that hospital chain Health Management Associates, LLC, will pay $5.5 million to Florida to resolve claims that two HMA hospitals, Charlotte Regional Medical Center and Peace River Medical Center, billed the Florida Medicaid program for services referred by physicians to whom HMA provided remuneration in return for patient referrals.  The unlawful remuneration took the form of free rent, office space, and staff services, as well as direct payments purportedly meant to cover overhead and administrative costs.  FL AG

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid,

December 17, 2018

Margarita Palomino, of Homestead, Florida, has been sentenced to over six years in prison for her part in a health care scheme which defrauded Medicare out of $4.65 million. The scheme involved three home health agencies that claimed to provide services to Medicare patients. Palomino, licensed as a physician in Cuba, but not in the United States, admitted that she provided home health care nursing visits and prepared the accompanying medical records as would a licensed medical professional in the U.S. Furthermore, between the approximate time of January 2010 and January 2014, Palomino admitted to accepting kickbacks in return for the referral of Medicare beneficiaries, the majority of whom did not need or even qualify for the services. In addition to spending 78 months in prison, Palomino has been ordered to pay $4,658,241.00 in restitution and to forfeit $186,650.50.  DOJ        

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

December 11, 2018

A New York-based audiology practice has agreed to pay $566,263.08 in connection with alleged violations of the False Claims Act and Anti-Kickback Statute. According to an unnamed whistleblower, Oviatt Hearing and Balance, LLC improperly billed Medicare and TRICARE for services rendered by unlicensed and unsupervised employees, as well as provided inappropriate inducements in the form of free iPads, Butterball turkeys, and gift cards, to Medicare and TRICARE beneficiaries to get them to choose Oviatt over other providers. For their role in exposing the fraud, the whistleblower stands to receive a relator's share of $120,000. USAO NDNY

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

December 11, 2018

Aurora Health Care, Inc. has agreed to pay $12 million to settle allegations of defrauding Medicare and Wisconsin's Medicaid program in certain reimbursement claims filed between 2008 to 2012. According to the United States and State of Wisconsin, the healthcare provider and two physicians entered into improper financial relationships in violation of the federal and state False Claims Acts as well as the Stark Law. As a result, some of the claims that Aurora submitted to the government health programs were improper. Despite alerting the government to the illegal arrangement, a qui tam complaint filed by unnamed whistleblowers alleged different claims. Although the whistleblowers will still receive a share of the recovery, the government did not intervene in their lawsuit, which will be dismissed as part of the settlement. USAO EDWI

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Whistleblower Case,

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