Archive

February 13, 2018

Detroit-area doctor Mahmoud Rahim was sentenced to 72 months in prison and ordered to forfeit roughly $1.7 million for his role in a $10.4 million conspiracy to defraud the Medicare program. According to the evidence presented at trial, Rahim accepted kickbacks in exchange for referring Medicare patients for electromyogram tests, some of which were unnecessary, and physical therapy performed by unlicensed individuals. DOJ

Tagged in: Anti-Kickback and Stark, Improper Medical Personnel, Lack of Medical Necessity, Provider Fraud,

February 8, 2018

Privately owned for-profit hospice company Horizons Hospice, LLC and its owner agreed to pay roughly $1.2 million to settle claims they violated the False Claims Act for billing Medicare and Medicaid for hospice services for patients who were ineligible for hospice. The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act. DOJ (WDPA)

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Multiple Whistleblowers and First-to-File, Whistleblower Case,

January 30, 2018

Tampa’s largest ambulance providers AmeriCare Ambulance Service, Inc. and its sister company AmeriCare ALS, Inc. agreed to pay roughly $5.5 million to settle claims they violated the False Claims Act by billing Medicare for medically unnecessary ambulance transportation services. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former AmeriCare employee Ernest Sharp. He will receive a whistleblower award of roughly $1.15 million from the proceeds of the government’s recovery. DOJ (MDFL)

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

January 24, 2018

Tennessee chiropractor Matthew Anderson agreed to pay $1.45 million to resolve allegations he violated the False Claims Act. Specifically, the government alleged that Anderson and his management company, PMC LLC, caused pharmacies to submit requests for Medicare and TennCare payments for pain killers dispensed based upon prescriptions written at the Cookeville Center for Pain Management, one of the pain clinics Anderson managed, which had no legitimate medical purpose. The government further alleged that Anderson caused four pain clinics he managed to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. The allegations originated in a whistleblower lawsuit filed by a former office manager for the Cookeville Center for Pain Management under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $246,500 from the proceeds of the government's recovery. DOJ

Tagged in: Chiropractic, FCA Federal, Lack of Medical Necessity, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

January 23, 2018

California medical device company DJO Global Inc. agreed to pay $7.62 million to resolve allegations that its Minnesota subsidiary Empi Inc. submitted false claims to TRICARE for excessive, unnecessary transcutaneous electrical nerve stimulation electrodes that TRICARE beneficiaries did not need or use. TENS is a therapy that uses low-voltage electrical current for pain relief. DOJ

Tagged in: Lack of Medical Necessity, Medical Devices and DME, Other Government Health Programs,

January 18, 2018

Detroit-area doctor Gerald Daneshvar was sentenced to 24 months in prison for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulted in inappropriately high payments. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding,

January 10, 2018

Florida pharmacy Healthy Meds Pharmacy Corp. agreed to pay $350,000 to settle allegations under the False Claims Act for filling prescriptions in violation of TRICARE’s policy on telemedicine. According to the government, Healthy Meds engaged in unsolicited calls to TRICARE beneficiaries, provided medically unnecessary compound medications to beneficiaries, and knowingly filled prescriptions from doctors who did not meet or properly consult with TRICARE beneficiaries. DOJ (SDFL)

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Lack of Medical Necessity, Other Government Health Programs,

December 29, 2017

Maryland physician Nwaehihie H. Onyeaghala of Krystal Medical Associates, LLC agreed to pay $1 million to settle allegations he violated the False Claims Act by submitting false claims to Medicare for medically unnecessary autonomic nervous function tests and peripheral vascular tests. According to the government, the tests were not medically necessary because Dr. Onyeaghala lacked the necessary equipment to conduct the tests, the patients did not have an autonomic nervous function disorder before the test was conducted, Dr. Onyeaghala lacked the specific training to conduct such tests and he only used the tests to monitor patient symptoms, not make any clinical decisions about future patient care. DOJ (DMD)

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

December 28, 2017

Maryland physician Jui Chih Hsu agreed to pay roughly $1.2 million to settle claims of violating the False Claim Act by submitting false claims to Medicare for medically unnecessary vitamin injections and evaluation and management services that were not documented. DOJ (DMD)

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

December 21, 2017

Florida-based Haven Hospice agreed to pay roughly $5 million to resolve allegations that Haven violated the False Claims Act by knowingly billing the government for medically unnecessary and undocumented hospice services. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Haven employee Dr. John Simons. Dr. Simons will receive a whistleblower award of roughly $900,000 from the proceeds of the government's recovery. DOJ (MDFL)

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

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