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July 22, 2021

Medical laboratory Bluewater Toxicology, LLC, agreed to pay $1.2 million following its self-report of overbilling for urine drug testing services.  In billing Medicare, Kentucky Medicaid, Indiana Medicaid, TRICARE, and CHAMPVA, Bluewater was alleged to have submitted false claims that misrepresented the number of drugs tested in definitive urine drug tests, that lacked sufficient documentation, or that were for specimen validity testing that is not separately billable to Medicare.  USAO ED KY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud,

July 21, 2021

Alliance Family of Companies LLC, a national electroencephalography testing company, and Ancor Holdings LP, a private insurance company, have agreed to pay a combined $15.3 million to resolve alleged violations of the False Claims Act and Anti-Kickback Statute.  According to a number of whistleblowers, Alliance provided free electroencephalography (EEG) interpretation reports to induce physician orders, caused physicians to submit false claims to the government, used inaccurate billing codes to generate higher reimbursements, and billed for a specialized digital analysis that it didn’t actually perform.  The whistleblowers also alleged that while performing due diligence prior to investing in Alliance, Ancor learned of the kickbacks but allowed them to continue after the change in management.  Two of the whistlebl­owers involved will share a reward of nearly $3 million.  DOJ

Tagged in: Anti-Kickback and Stark, Defendants, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

July 20, 2021

Sage Consulting Group, Inc., and its president and owner Robert Pleghardt, agreed to pay $4.8 million to resolve claims that they paid kickbacks to two business, Wete & Company, Inc. and Index Systems, Inc., which were SBA certified as small businesses owned and operated by socially and economically disadvantaged individuals, to permit Sage to represent that those companies would be performing at least 50% of the work as subcontractors on Sage’s contracts with the Department of Defense Education Activity and Defense Human Resources Activity when, in fact, Sage performed 100% of the work.  USAO EDVA

Tagged in: Defense Contract Fraud, FCA Federal, Government Procurement Fraud, Set-Asides and Preferences,

July 20, 2021

Rheumatologist Enrico Arguelles and his practice, Arthritis and Osteoporosis Center of Billings, Montana, agreed to pay $1.27 million and relinquish Medicare claims for $802,000 in settlement of claims that they improperly billed for MRI scans and patient visits, and billed for biologic infusions such as Remicade where the treatment was not medically necessary.  USAO MT

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

July 19, 2021

Prime Healthcare Services, one of the largest hospital systems in the nation, its founder and CEO Dr. Prem Reddy, and interventional cardiologist Dr. Siva Arunasalam have agreed to pay $37.5 million to resolve two suits filed by former executive Martin Mansukhani, and former employees Marsha Arnold and Joseph Hill.  In violation of the federal and California False Claims Acts, certain Prime hospitals had allegedly submitted inflated invoices to Medi-Cal and other government health programs, or submitted claims to Medi-Cal and Medicare under Arunasalam’s provider number for services provided by an excluded physician.  Additionally, in acquiring Arunasalam’s physician practice and surgery center, Prime allegedly paid above fair market value for referrals from Arunasalam to one of their hospitals.  For being the first to file, one of the whistleblowers, Mansukhani, will receive a relator’s share of nearly $10 million.  CA AG; USAO CDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 16, 2021

Florida Neurological Center, LLC and its owner Dr. Lance Kim have agreed to settle a whistleblower-brought suit and pay $800,000 to resolve allegations of defrauding Medicare.  The qui tam suit by Michael Singbush, Andrea Herrera, and Harvey Kessler Meyer, IV alleged that Dr. Kim prescribed medically unnecessary prescription drugs, which cost Medicare $35,000 each time it was prescribed.  For their role in the successful enforcement action, the whistleblowers will share in a $144,000 award.  USAO MDFL

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

July 12, 2021

The Florida Department of Children and Families (FDCF) has agreed to pay $17.5 million and forgo payment of $14.7 million in unpaid bonuses to resolve allegations that it submitted false information to the USDA’s Supplemental Nutrition Assistance Program (SNAP), which was known as the Food Stamp Program until 2008.  Although the USDA reimburses states for administering SNAP, it relies on the states to determine applicant eligibility, administer benefits, and perform quality control.  FDCF allegedly failed to have proper quality control procedures in place, resulting in false information submitted to the USDA, for which they received unentitled performance bonuses from 2011 through 2014.  USAO EDWA

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

July 9, 2021

Genetworx Laboratories, a diagnostic laboratory in Virginia, has agreed to pay $1.4 million to resolve allegations of submitting false claims to Medicare in violation of the False Claims Act.  Over the course of a year, Genetworx allegedly billed for genetic tests that were performed on groups of senior citizens in senior homes without valid physician oversight.  USAO NJ

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

July 8, 2021

Alere Inc. and Alere San Diego Inc. have agreed to pay nearly $39 million to settle allegations of knowingly selling defective blood coagulation monitors, which are used to determine safe dosages of anticoagulant drugs, to Medicare beneficiaries.  Too much anticoagulant could result in massive bleeding, while too little can result in blood clots and strokes.  By 2008, Alere had allegedly become aware of the fact that the software used in its INRatio monitors contained a material defect that caused some patients to see inaccurate results.  Although the company was also aware of dozens of deaths and hundreds of injuries associated with the devices, it failed to take them off the market and even continued to bill Medicare for them, in violation of the False Claims Act, until the FDA requested a Class I recall in 2016.  USAO NJ

Tagged in: Defective Products, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare,

June 28, 2021

Surgical Care Affiliates, LLC and Orlando Center for Outpatient Surgery, LP have agreed to pay $3.4 million to resolve a whistleblower’s allegations that they billed Medicare and TRICARE for medically unnecessary kidney stone procedures.  The centers also engaged in an illegal kickback arrangement whereby urologist Dr. Patrick Hunter performed lithotripsy procedures in exchange for per-procedure payments from the Orlando Center.  For bringing a successful action, whistleblower Scott Thompson will receive a relator’s share of $748,000 from the settlement with SCA and the Orlando Center.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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