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August 3, 2017

The Medical Center of Central Georgia, Inc. (d/b/a The Medical Center, Navicent Health) agreed to pay roughly $2.6 million to resolve allegations it violated the False Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Navicent paramedic Andre Valentine.  He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (MDGA)

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

July 17, 2017

Ohio-based nursing home operators Foundations Health Solutions Inc., Olympia Therapy Inc. and Tridia Hospice Care Inc., and their executives Brian Colleran and Daniel Parker, agreed to pay roughly $19.5 million to resolve allegations they violated the False Claims Act by submitting to Medicare claims for medically unnecessary rehabilitation therapy services and for hospice services to patients not eligible for the Medicare benefit, and by soliciting and receiving kickbacks to refer patients from their skilled nursing facilities to home health care provider Amber Home Care LLC.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by former Olympia employee Vladimir Trakhter and former Tridia employees Paula Bourne and La’Tasha Goodwin.  Mr. Trahkter will receive a whistleblower award of roughly $2.9 million and Ms. Bourne and Ms. Goodwin collectively will receive an award of roughly $740,000, all from the proceeds of the government’s recovery.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, Home Health and Hospice, Lack of Medical Necessity, Multiple Whistleblowers and First-to-File, SNF, Whistleblower Case, Whistleblower Rewards,

July 14, 2017

Rodney Hesson and Gertrude Parker, owners of Nursing Home Psychological Services and Psychological Care Services, were respectively sentenced to 180 months and 84 months in prison and to respectively pay $13.8 million and $7.3 million in restitution for their involvement in a $25.2 million Medicare fraud scheme involving billing Medicare for psychological testing services that nursing home residents did not need or in some instances did not receive.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF,

July 6, 2017

Pennsylvania hospice company Compassionate Care of Gwynedd Inc., and a subsidiary of New Jersey-based Compassionate Care Hospice Group Inc., agreed to pay $2 million to resolve allegations it violated the False Claims Act by providing unnecessary hospice services.  The government alleged the company admitted patients by using a diagnosis of “debility” that was not medically justified.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive an award of more than $350,000 from the proceeds of the government's recovery.  DOJ (DNJ)

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

July 5, 2017

Reliant Care Group, Reliant Care Management Company, Reliant Care Rehabilitative Services, and a number of Reliant affiliated skilled nursing facilities agreed to pay roughly $8.4 million to settle charges they violated the False Claims Act by billing Medicare for unnecessary physical, speech, and occupational therapy to nursing home residents.  DOJ (EDMO)

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF,

June 26, 2017

Dr. Miguel Burgos, the medical director of four Florida infusion clinics, and Yosbel Marimon, the owner of the clinics, were sentenced respectively to 64 months and 90 months in prison for their roles in a $13.7 million Medicare fraud conspiracy that involved submitting claims for expensive infusion-therapy drugs that were never purchased, never provided and not medically necessary.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud,

August 4, 2017

Georgia announced a civil settlement with The Medical Center of Central Georgia, Inc., more commonly known as The Medical Center, Navicent Health (Navicent). Navicent agreed to pay to the United States and the State of Georgia $2,549,742 to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary. Additionally, Navicent’s current Corporate Integrity Agreement (CIA) will be heightened and extended to cover the newly resolved conduct. A CIA is an agreement between a private provider of services and the United States whereby the provider, at its own expense, institutes and maintains a program, overseen by the OIG with reviews by an independent review organization, to insure compliance with the laws and regulations regarding participation in federally funded programs. GA

Tagged in: FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

July 17, 2017

Former Olympia Therapy Inc. employee Vladimir Trakhter and former Tridia Hospice Care Inc. employees Paula Bourne and La’Tasha Goodwin will collectively receive a whistleblower award of more than $3.6 million from the roughly $19.5 million Olympia, Tridia and Foundations Health Solutions Inc. agreed to pay to resolve allegations they violated the False Claims Act by submitting to Medicare claims for medically unnecessary rehabilitation therapy services and for hospice services to patients not eligible for the Medicare benefit, and by soliciting and receiving kickbacks to refer patients from their skilled nursing facilities to home health care provider Amber Home Care LLC.

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

June 22, 2017

Dr. James M. Crumb, a physical medicine and rehabilitative specialist currently practicing in Alabama as Mobility Metabolism and Wellness, P.C.,and Coastal Neurological Institute, P.C., a local neurosurgeon physician group, agreed collectively to pay $1.4 million to resolve allegations they violated the False Claims Act by billing federal health care programs for medically unreasonable and unnecessary ultrasound guidance used with routine lab blood draws, and with Botox and trigger point injections. As a result of this billing scheme, the defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient office visit. DOJ (SDAL)

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

June 16, 2017

Pennsylvania-based skilled nursing facility operator Genesis Healthcare Inc. agreed to pay roughly $53.6 million to settle charges that companies and facilities acquired by Genesis violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Joanne Cretney-Tsosie, Jennifer Deaton, Kimberley Green, Camaren Hampton, Teresa McAree, Terri West, and Brian Wilson, former employees of companies acquired by Genesis. They collectively will receive a whistleblower award of $9.67 million from the proceeds of the government's recovery. DOJ

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

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