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June 18, 2018

Connecticut has reached a $200K FCA settlement with Dr. Elijah Caldwell, a behavioral health clinician, and two practices that he owns or controls. According to the state, Dr. Caldwell billed Connecticut’s Medicaid program for psychotherapy services that were never rendered. In addition to the monetary settlement, Dr. Caldwell will be excluded from the Medicaid program for the next decade. The fraud was brought to light by a whistleblower. CT

Tagged in: FCA State, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

June 12, 2018

North Carolina announced the sentencing of Dr. Duke Ellington Ellis, who allegedly assisted Nature’s Reflections, a Durham-based behavioral health company, forge the signature of a licensed psychologist in order to submit millions of dollars in false claims to Medicaid. Ellis will face thirteen months in prison and will pay over a million dollars in restitution to the North Carolina Medicaid Program. NC

Tagged in: FCA State, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

June 8, 2018

Disgraced former neurologist Rassan Tarabein-who operated Alabama’s Eastern Shore Neurology and Pain Center-was sentenced to 60 months in prison and ordered to pay over $15 million and forfeit his medical license after he pled guilty to orchestrating a thirteen-year scheme in which he induced  Medicare, Medicaid, and privately-insured patients to visit his clinic and undergo medically unnecessary tests and procedures. USAO SDAL

Tagged in: Lack of Medical Necessity, Provider Fraud,

June 7, 2018

Mississippi physician Albert Diaz was sentenced to 42 months in prison for prescribing medically unnecessary compounded medications to TRICARE patients he had not examined and falsifying medical records to make it appear he had treated the patients. The fraud cost TRICARE and other insurers more than $3 million. DOJ

Tagged in: Compounding Pharmacy Fraud, Other Government Health Programs, Provider Fraud,

June 5, 2018

Louisiana-based post-acute healthcare management company Allegiance Health Management will pay over $1.7 million to resolve False Claims Act allegations it billed Medicare for intensive outpatient psychotherapy services to hospitalized patients who did not need the services, received inappropriate levels of treatment, or were provided nontherapeutic treatment. The settlement also resolves claims Allegiance Health Management failed to provide treatment pursuant to an individualized treatment plan and neither tracked nor document patient progress adequately. The suit was brought by whistleblower and former Allegiance employee Ryan Ladner, who will receive a $300,000 share of the settlement. DOJ

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

June 5, 2018

New York announced an $883,000 settlement with City Practice Group of New York, LLC (CityMD), a New York City urgent-care chain, for causing its affiliates to overbill New York State’s Empire Plan for facility fees for which they were not entitled. This practice resulted in $197,390.52 in overbilling to the government employee health insurance plan. The state investigation was prompted by a whistleblower who filed a lawsuit against CityMD under the New York False Claims Act. The whistleblower will receive over $176,000 from the settlement for bringing this misconduct to light. NY

Tagged in: Healthcare Fraud, Provider Fraud,

June 1, 2018

Multi-state physical therapy provider Team Work Ready CEO Jeffrey Rose Sr. was sentenced to more than 19 years imprisonment for his role in an $18 million fraud scheme in which he and his co-conspirators billed the DOL for inadequate and inappropriate care, as well as for one-on-one physical therapy services never provided. USAO SDTX

Tagged in: Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

May 31, 2018

New York doctor Thomas Savino was sentenced to four years in prison, fined $100,000, and ordered to forfeit $27,500 for violating the AKS and other laws by accepting at least $25,000 in cash brides from Biodiagnostic Laboratory Services LLC in exchange for referring patient blood samples to the lab. USAO DNJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Provider Fraud,

May 29, 2018

Following a two-week jury trial, LaTonya Mallory, Floyd Calhoun Dent III, and Robert Bradford Johnson were collectively found liable for $114 million for violating the False Claims Act and Anti-Kickback Statute by paying physicians for patient referrals to two blood-testing laboratories, and for causing those laboratories to bill federal health care programs for medically unnecessary testing. The verdict resolves three separate whistleblower suits filed by Dr. Michael Mayes, Scarlett Lutz, Kayla Webster, and Chris Reidel, who will receive a yet-to-be-determined share of any recoveries. USAO DDC

Tagged in: Anti-Kickback and Stark, FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 25, 2018

Florida pain management clinic Riverside Spine & Pain Physicians agreed to pay $1.2 million to settle allegations under the False Claims Act that it billed federal health care programs for medically unnecessary tests and indiscriminately ordered quantitative urine drug tests; whistleblower and former employee Dr. Carissa Stone will receive approximately $240,000 for her role in shining a light on the fraud. USAO MDFL

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

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