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Page 24 of 42

July 16, 2018

Two additional Southern California surgeons have been indicted in a kickback scheme that is alleged to have generated over a billion dollars in fraudulent claims to federal and California healthcare programs. The two physicians were charged for their roles in receiving kickbacks to refer patients to Pacific Hospital. USAO Central District of California

July 13, 2018

Orthopedic specialists in Oklahoma have agreed to pay $670,000 to settle allegations in a False Claims Act qui tam that they falsely billed Medicare, Medicaid, and Tricare for unnecessary ultrasonic guidance procedures and for services that were not performed.  The settlement resolved two claims in the whistleblower action, brought by a former employee, in which the government had intervened prior to settlement; other claims continue to be litigated.  USAO WDOK

July 10, 2018

The New Mexico U.S. Attorney’s Office announced the sentencing of a cardiologist to 51 months in prison for healthcare fraud and obstruction of justice.  Roy Heilbron had been indicted for regularly performing unnecessary diagnostic tests on his patients and falsifying medical records to cover the fraudulent billing; he also had billed for procedures that were never performed.  USAO NM

July 3, 2018

A Virginia woman who owned several Medicaid support services companies has agreed to pay $1 million and to accept a lifetime ban on participation in the Virginia Medicaid Program as part of a settlement of allegations that she defrauded the program.  Dawn Sykes allegedly paid illegal kickbacks and sought reimbursement for services that were not provided or were provided to ineligible recipients.  The investigation was launched by a qui tam lawsuit under the FCA and Virginia Fraud Against Taxpayers Act, and the whistleblower will receive 18 percent of the settlement.  USAO EDVA

July 2, 2018

FWC Urogynecology, LLC agreed to pay $1.7 million to settle allegations under the False Claims Act. FWC allegedly misused Medicare billing codes by billing modifier 25 for services that were not billable or that it did not provide. The alleged conduct occurred between 2012 and 2017. USAO MDFL

July 3, 2018

The state and federal governments reached a joint settlement resolving allegations that a Waterford psychologist submitted false claims for behavioral health services she never provided to her Connecticut Medicaid patients, Attorney General George Jepsen and Connecticut Department of Social Services (DSS) Commissioner Roderick L. Bremby. Dr. Arlene Werner, a licensed psychologist and owner and sole practitioner of a private psychology practice, will pay $126,760.09 and has been suspended from participation in the Connecticut Medical Assistance Program (CMAP) – which includes the state’s Medicaid program – for a period of two years. The state and federal governments alleged that, from January 2011 to July 2016, Dr. Werner submitted false claims to the CMAP for psychotherapy services that were not provided to her CMAP patients. CT

June 28, 2018

Varicose vein treatment company Circulatory Centers of America, LLC agreed to pay $1,205,000 to settle allegations that it violated the False Claims Act. The allegations stemmed from a qui tam lawsuit filed by a whistleblower in Pittsburgh, PA that alleged claims were submitted to Medicare for services by non-physicians “incident to” the supervision by a physician when in fact no physician was present in the office. These types of claims are reimbursed at higher rates than when billed without the physician supervision component. USAO WDPA

June 21, 2018

Connecticut has sued a behavioral health provider, Susan Britt, for violations of its FCA. Britt is a licensed professional counselor who runs her own practice, Inner Peace. According to the state’s allegations, Britt would provide counselling services to children, then meet with parents to discuss their children’s progress, and bill the state Medicaid program as if she provided counseling services to both parents and children. During the time period in question, Britt billed the state over $530K. CT

June 20, 2018

Healogics, a Florida-based company which runs a chain of wound care centers, has settled FCA allegations that it improperly billed for hyperbaric oxygen therapy (a modality in which the entire body is exposed to oxygen under increased atmospheric pressure, as an adjunctive therapy to treat certain chronic wounds). The company paid $22.5M to settle allegations that it billed for unnecessary or unreasonable hyperbaric oxygen therapy. The allegations were brought to the government’s attention by four whistleblowers, James Wilcox, Dr. Benjamin Van Raalte, Dr. Michael Cascio, and John Murtangh. The whistleblowers will receive a $4.28M reward. Separately, Healogics also paid $398K to settle another FCA case alleging that it improperly applied Modifier 25, which signifies that a separate evaluation and management service was performed on the same day as another procedure, to claims that were sent to Medicare, Medicaid, and TRICARE. The allegations were brought to light by a whistleblower, who will receive a $91K reward. DOJUSAO Northern District of Iowa

June 18, 2018

Ronald Grusd, a Beverly Hills radiologist, was sentenced to 10 years in prison for his role in a massive worker’s comp scheme. The scheme involved the payment of over $100k in kickbacks in exchange for referrals or workers’ comp patients for a variety of services, including MRIs and ultrasound scans. Dr. Grusd billed over $22M in services based on these referrals. USAO Southern District of California
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