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August 17, 2021

Following a voluntary self-disclosure to authorities, Blessing Hospital in Quincy, Illinois, has agreed to pay $2.82 million to resolve allegations that it submitted false claims for the facility component of medically unnecessary cardiac catheterization procedures.  The federal government will receive $2.6 million of the settlement, with the remainder going to Illinois, Iowa, and Missouri.  USAO CD IL

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

August 9, 2021

Ralph Hackett, a fruit broker in California’s Central Valley, will pay $1.255 million to resolve criminal charges and civil claims arising from his role in a crop insurance fraud scheme.  In a guilty plea, Hackett acknowledged that he authorized alterations to business records and misstatements to underreport the table grapes sold by another individual, so that the individual could submit fraudulent crop insurance claims between 2012 and 2015.  Hackett agreed to pay criminal restitution of $650,000 and a civil penalty of $605,000; his prison sentence is yet to be determined.  USAO ED Cal

Tagged in: Criminal Proceedings, Crop Insurance, FCA Federal, FIRREA,

August 9, 2021

The owners of North Carolina compounding pharmacy Wellcare Compouding, David Tsui and Lois Tsui, paid $1.1 million to resolve allegations that they violated the False Claims Act by submitting false claims for payment to the TRICARE program in 2014 and 2015.  The government alleged that Wellcare made improper payments to physicians and “marketers” in violation of the Anti-Kickback Statute and encouraged medically unnecessary prescriptions consisting of high-margin ingredients in order to maximize the pharmacy’s reimbursement. David Tsui had been convicted of healthcare fraud in 2009 and was excluded from participation in federal healthcare programs; the government alleged that his involvement and ownership was intentionally concealed.  USAO MD NC

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

August 6, 2021

A county in California and a county medical center have agreed to pay $11.4 million to resolve allegations of improperly billing a federal healthcare program between 2013 and 2017.  According to whistleblower Felix Levy, a former employee of San Mateo County Medical Center (SMMC), San Mateo County and SMMC billed Medicare for uncovered hospital stays for patients that were admitted without regard to medical necessity.  USAO NDCA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case,

August 5, 2021

Tennessee’s Department of Human Services has agreed to pay nearly $7 million to resolve allegations of submitting false information to the USDA’s Supplemental Nutrition Assistance Program, known until 2008 as the Food Stamp Program.  Under the direction of the Julie Osnes Consulting firm, numerous state agencies—including Alaska, Florida, Louisiana, Mississippi, Texas, Virginia, and Wisconsin—allegedly submitted false quality control data to the USDA, receiving performance bonuses as a result.  This is the ninth settlement in the matter; more than $67 million has been recovered thus far.  USAO EDWA

Tagged in: Defendants, FCA Federal, Government Programs Fraud,

August 5, 2021

Ascension Michigan and related hospitals, which allegedly billed federal healthcare programs for services performed by a gynecologic oncologist that were not medically necessary or rendered as represented, has agreed to pay $2.8 million to resolve their liability under the False Claims Act.  The settlement resolves claims from a 2017 qui tam suit by whistleblowers Pamela Satchwell, Dawn Kasdorf, and Bethany Silva-Gomez, that Ascension knowingly submitted claims for medically unnecessary hysterectomies and chemotherapy, and unrendered evaluation and management services.  Spurred by patient complaints, Ascension launched an internal investigation, ultimately self-disclosing the misconduct to the government in 2018.  As part of the settlement, Satchwell, Kasdorf, and Silva-Gomez will share in a $532,000 award.  USAO EDMI

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

August 2, 2021

Diabetic testing supply company Arriva Medical LLC and its parent company Alere Inc. will pay $160 million to resolve claims first brought in a whistleblower case alleging that Arriva provided unlawful patient inducements in the form of “free” or “no cost” glucometers and copayment waivers.  Defendants were alleged to have systematically provided all new patients with glucometers, and billed Medicare for those meters, although Medicare beneficiaries are only eligible for a new meter once every five years.  In addition, Arriva was alleged to have billed Medicare for deceased beneficiaries.  The whistleblower, Gregory Goodman, who was an employee at an Arriva call center, will receive a whistleblower award of $28.5 million.  Executives at Arriva previously agreed to a settlement of claims against them.  DOJ; USAO MD Tenn

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

July 28, 2021

Clothing companies Stargate Apparel, Inc. (now known as Excel Apparel Corp.), Rivstar Apparel, Inc. (now defunct), and former CEO and owner Joseph Bailey have agreed to pay a total of $6 million to settle a whistleblower’s allegations that they submitted false claims to U.S. Customs and Border Protection (CBP).  Between 2004 and 2015, Stargate, Rivstar, and Bailey allegedly engaged in two different fraud schemes to avoid paying millions of dollars in customs duties.  Both of the schemes involved submitting separate invoices to the CBP, which underreported the true value of goods being imported into the United States.  USAO SDNY

Tagged in: Customs Fraud, FCA Federal, Whistleblower Case,

July 23, 2021

Alabama non-profit SpectraCare Health Systems, Inc., which provides services including developmental disability services, intermediate care medical services, and behavioral health services, agreed to pay $1 million to resolve claims first brought in a whistleblower action alleging that the provider improperly billed Alabama Medicaid and failed to return overpayments to the Alabama Medicaid Agency.  The defendant was alleged to have submitted false claims including claims without correct and complete documentation, and duplicate claims, and to have knowingly retained payments it received to which it was not entitled.  The settlement will be split between the federal government and the Alabama Medicaid Agency, with the whistleblower receiving 19% of the federal recovery.  USAO MD AL

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 23, 2021

California-based Interface Rehab has agreed to pay $2 million to settle claims arising from a qui tam suit by its former director of rehab, Keith Pennetti.  According to Pennetti, Interface violated the False Claims Act when it pressured its therapists to increase the amount of therapy provided to Medicare Part A residents at eleven facilities, with no regard to medical necessity, and caused false claims to be submitted to Medicare.  For instigating the action, Pennetti will receive $360,000 of the settlement proceeds.  USAO CDCA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF, Upcoding, Whistleblower Case, Whistleblower Rewards,

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