Archive

June 24, 2020

Augusta University Medical Center (AUMC) has agreed to pay $2.6 million to resolve fraud allegations by the United States, State of Georgia, and State of South Carolina under state and federal False Claims Acts. According to the government, AUMC knowingly submitted claims to Medicare and Medicaid for a medically unnecessary procedure that was billed as a covered procedure. USAO SDGA

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

June 16, 2020

A doctor in Mississippi has been sentenced to four years in prison and ordered to pay nearly $5 million in restitution and judgment for committing healthcare fraud against multiple insurers, including TRICARE. In exchange for a 35% cut of reimbursements, Dr. Shahjahan Sultan had agreed to enter into a contract with a local pharmacy to prescribe expensive compound medications to insured patients, which he did without regard to medical necessity, and which resulted in over $8 million in losses to insurers. USAO SDMS

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

June 5, 2020

Alaska Neurology Center LLC and its owner, Franklin Ellenson, M.D., have agreed to pay $2 million and enter into a three-year Integrity Agreement to resolve allegations of submitting false claims to federal healthcare programs between 2013 to 2018. A whistleblower complaint revealed the defendants had engaged in a bevy of fraudulent billing schemes, including using false dates to bypass caps in reimbursement, billing for services provided by unqualified personnel, billing for non-reimbursable services, using multiple billing codes for procedures covered by a single code, using false names for providers, and resubmitting already rejected claims using false service or diagnosis information. The whistleblower in this case will receive a relator’s share of $380,000. USAO AK

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

May 7, 2020

Seattle Pain Center, Northwest Analytics, and owner/physician Dr. Frank Danger Li have agreed to pay $2.85 million to settle allegations of defrauding Washington’s Medicaid program. An investigation revealed that between 2013 and 2015, Li had instituted a policy required nearly every patient treated at Seattle Pain Center to be administered the full urine drug panel at each visit even if they were not medically necessary. The drug tests were then sent to Li’s exclusively-owned laboratory to be analyzed. Additionally, the investigation revealed that between 2007 and 2016, Li wrote an excessive amount of prescriptions for opioids, and at least 60 of his patients died due to opioid-related causes during this period. AG WA; USAO WDWA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Provider Fraud,

April 29, 2020

North Carolina physician Ibrahim Oudeh and his wife Teresa Sloan-Oudeh will pay up to $8.8 million to resolve claims of Medicare and Medicaid fraud. Between 2010 and 2017, the Oudehs reportedly submitted more than 40,000 false claims, including more than 37,000 claims for laboratory tests, including nerve-conduction studies that Dr. Oudeh was not qualified to interpret, the vast majority of which were medically unnecessary. To submit as many claims as they did, defendants falsely billed for office visits, in some instances billing for more than 24 hours of visits in a single calendar day. The Oudehs sometimes used outside physicians to interpret laboratory tests, but paid those physicians less than their practice’s Medicare reimbursement, a violation of the Anti-Markup Rule. Defendants will forfeit $3.3 million in assets and pay an additional $5.5 million. USAO EDNC; NC

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

April 21, 2020

KPMD, Inc., technology company in California, has been ordered to pay $1.7 million in restitution for defrauding Medicare and Medicaid. According to the DOJ’s press release, KPMD entered into a contract with Ohio-based Southwest Regional Medical Center in 2011 where it agreed to implement an electronic health records software program for the hospital in exchange for government incentive payments under the federal Health Information Technology for Economic and Clinical Health Act (HITECH Act). After KPMD’s CEO purchased the hospital, however, the company falsely attested to meeting criteria for the incentive payments even though the hospital was winding down operations. $1.3 million of the settlement will go to Medicare, with the remaining $800,000 to go to Medicaid. USAO SDOH

Tagged in: Certifications, Healthcare Fraud, Medicaid, Medicare,

April 15, 2020

A Florida-based reference laboratory, pain clinic, and two former executives have agreed to pay $41 million to settle claims of defrauding Medicaid, Medicare, TRICARE, and other government health programs by billing for medically unnecessary urine drug tests between 2010 to 2017. Led by Michael T. Doyle and Christopher Utz Toepke, the defendants allegedly had a policy of automatically ordering both presumptive and definitive urine drug tests for all patients at every visit regardless of need, with Toepke’s Tampa Pain Relief Centers Inc. performing all presumptive tests, and Doyle’s Logan Laboratories Inc. performing all definitive tests. The alleged False Claims Act violations were eventually brought to light in two qui tam cases; the whistleblowers of those cases will split a relator’s share of approximately $7.79 million. DOJ; EDPA; MDFL; FL

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

April 14, 2020

A chain of nine skilled nursing facilities operating in seven states has agreed to pay $10 million to settle a whistleblower-brought suit alleging violations of the False Claims Act. In the suit, former employees Hope Wright, Laura Webb, and Deborah Edmonds alleged that from 2013 to 2017, Saber Healthcare Group LLC improperly pressured therapists to provide Ultra High levels of rehabilitation therapy for all patients regardless of individual patient needs. Ultra High levels of therapy involve a minimum of 720 minutes of therapy from two therapy disciplines, and are reimbursed at the highest rate possible by Medicare. To enforce their illegal standard, Saber prevented therapists from providing lower levels of therapy, caused therapists to falsely report time, and pressured facility directors in daily or weekly calls. As part of the settlement, Saber has agreed to a five year Corporate Integrity Agreement, and Wright, Webb, and Edmonds will receive $1.75 million of the settlement proceeds. DOJ

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

April 10, 2020

To settle fraud allegations by four relators in three qui tam suits, Michigan-based Encore Rehabilitation Services LLC has agreed to pay $4 million to the United States. According to Linda Anderson, Reza Saffarian and Audrey Theile, and Adam LaFerriere, from roughly 2010 to 2018, the owner and operator of over 600 healthcare facilities allegedly caused three of its skilled nursing facilities to submit false claims to Medicare for services that were not medically necessary, reasonable, or provided by skilled therapists, and improperly billed group therapy sessions as if they were individual therapy sessions. DOJ; USAO EDMI; USAO WDMI

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicare, SNF, Whistleblower Case,

April 6, 2020

Following a $7.1 million settlement with seven co-defendants in October 2019, a chiropractor in New Jersey who allegedly concocted the scheme to bill Medicare for medically unnecessary injections and knee braces has agreed to pay $2 million to resolve his liability. A critical analysis of Medicare claims data revealed that while treating for osteoarthritis, David Podell caused his clinic and seven Osteo Relief Institutes to bill Medicare for viscosupplementation injections—gel-like fluids injected into the knee that act as lubricant—as well as custom knee braces for beneficiaries who did not need them. Additionally, the claims for the custom knee braces were tainted by illegal kickbacks that Podell solicited and received from the manufacturer. DOJ; USAO MN

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,

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