Archive

September 28, 2018

Kalispell Regional Healthcare System and six of its related entities agreed to pay $24 million to settle a False Claims Act case based on its compensation arrangements with physicians, which were alleged to violate the Stark Law, and other arrangements alleged to violate the Anti-Kickback Statute. Between 2010 and 2018, KRH entities reportedly paid excessive and above-market full-time compensation to more than 60 physicians, even if those physicians worked far less than full-time. In addition, some of the KRH entities were alleged to unlawfully seek referrals from physicians through excessive compensation arrangements and the provision of administrative services at below market rates. Jon Mohatt, the former CFO of a related entity, initiated the action with a qui tam filing; Mohatt will receive $5.4 million dollars as a relator's share of the government's recovery. DOJ

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

September 26, 2018

Health Management Associates, LLC (HMA)—now part of Community Health Systems Inc. (CHS)—has agreed to pay a combined $260 million to settle civil and criminal charges of defrauding Medicare, Medicaid, and TRICARE and violating the Anti-Kickback Statute, the Stark Law, and False Claims Act. The alleged fraud was revealed by eight whistleblowers and involved paying kickbacks to doctors for patient referrals, pressuring doctors to meet emergency patient admission quotas, billing outpatient or observational services as inpatient services, and inflating the cost of emergency services. The eight whistleblowers have been granted a combined $27 million award so far. DOJ; USAO EDPA; USAO SDFL; USAO WDNC

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

September 19, 2018

Calloway Laboratories, Inc.—a Massachusetts-based clinical laboratory—has been ordered to pay a civil judgment of $1,374,058 to settle claims first brought to light by a former employee in a whistleblower lawsuit. The laboratory allegedly violated the Anti-Kickback Statute, Stark Law, and False Claims Act over the course of six months by providing free testing supplies to doctors in exchange for referrals and then submitting reimbursement claims for testing arising from these improper referrals to Medicare and TRICARE. USAO EDKY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Other Government Health Programs, Whistleblower Case,

September 13, 2018

One of the owners of an unnamed compounded drug marketing company has pleaded guilty to defrauding a state employee health benefit plan. According to the complaint, over the course of a year, Robert Madonna and others bribed a number of state employees to obtain prescriptions for medically unnecessary but expensive compounded drugs, including vitamins and creams to manage fungus, pain, and scars. The alleged fraud caused more than $2 million in losses to the New Jersey State Health Benefits Plan. Madonna will now pay $2,092,791 in restitution and be sentenced early next year to a possible maximum of 10 years in prison and a $250,000 fine. USAO NJ

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Pharma Fraud,

September 11, 2018

Through a tip by Connecticut State Comptroller, Kevin Lembo, a Florida-based compounding pharmacy, Assured, Rx, along with multiple individuals—many of them former and current Connecticut state government employees—have been sued by the State of Connecticut for alleged violations of the Connecticut False Claims Act. The pharmacy is accused of paying kickbacks to co-defendants Nicholas and Lisette Maulucci, who then paid other individuals to file reimbursement claims from a state employee health plan for expensive compound drugs manufactured by Assured, Rx. Through their actions, the Mauluccis allegedly received kickbacks totaling upward of $2.6 million, and cost the Connecticut Pharmacy Benefit Plan approximately $10.9 million. CT AG

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA State, Pharma Fraud,

August 27, 2018

Following a lawsuit by whistleblower Dr. Stephen Dean, seven defendants in the ambulance industry have agreed to pay over $21 million altogether in order to settle claims that they violated the Anti-Kickback Statute and False Claims Act. The defendants with the largest fines—East Texas Medical Center and Paramedics Plus—had been accused of giving kickbacks to the others in exchange for their business. For his role in the case, Dr. Dean will receive $4.9 million. DOJ; EDTX

Tagged in: Ambulance, Anti-Kickback and Stark, FCA Federal, Whistleblower Case, Whistleblower Rewards,

August 23, 2018

Reliant Rehabilitation Holdings Inc has agreed to pay $6.1 million to settle claims brought on by whistleblower Dr. Thomas Prose that it paid kickbacks to doctors and nursing homes to promote its business and filed reimbursement claims arising from improper contracts — both violations of the False Claims Act. Under the settlement agreement, Dr. Prose will receive a relator’s share of $915,000. DOJ

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

August 16, 2018

Lincare, Inc—one of the largest home providers of respiratory therapy products and services in the nation—has paid $5.25 million to settle a suit filed by whistleblower Brian Thomas. In 2015, the former billing supervisor accused the company of violating the Anti-Kickback Statute and False Claims Act over a period of six years by unlawfully waiving or reducing fees paid by Medicare Advantage recipients and submitting false claims for reimbursement. Thomas will receive $918,750 for his role in exposing the alleged fraud. USAO SDIL

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

August 15, 2018

Post Acute Medical, LLC has agreed to pay $13,031,502 to the United States, $114,016 to Texas, and $22,482 to Louisiana to settle allegations brought on by whistleblower Douglas Johnson that it violated the Anti-Kickback Statute, Physician Self-Referral Law, and state and federal False Claims Acts. The operator of long-term care and rehabilitation hospitals nationwide was accused of cultivating "reciprocal referral relationships" with outside healthcare providers and then billing Medicare and Medicaid for services that arose from those relationships. For his role in exposing the alleged fraud, Johnson will receive a cut of the federal government's share totaling $2,345,670. DOJ

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

August 10, 2018

Trinity Medical Pharmacy, LLP and several members of its leadership have agreed to pay $2,244,270.14 to settle allegations that it violated the False Claims Act by giving illegal kickbacks to patients and providers, billing TRICARE and other government programs for medical reimbursement claims arising from those kickbacks, and failing to disclose information that would have barred it from becoming a provider for Express Scripts, which provides pharmaceutical services for TRICARE. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud,

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