Archive

April 10, 2017

Kentucky based nursing home operator Prestige Healthcare agreed to pay $995,500 to resolve allegations it violated the False Claims Act with regard to its role in an alleged scheme to falsely bill Medicare for unnecessary genetic testing. According to the government, Prestige provided genetic testing company Genomix LLC with information on and access to Prestige nursing home patients without ensuring physician orders were obtained for the testing and where Prestige physicians were not aware of and did not agree with the medical necessity of the testing. DOJ (WDWI)

Tagged in: FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, SNF,

April 20, 2017

California announced a $9.8 million settlement with Walgreens, one of the largest drugstore chains in the United States. The settlement involved allegations that Walgreens failed to adhere fully to requirements imposed by California law for the dispensing of certain prescriptions drugs under Medi‑Cal. The settlement is the result of lawsuits filed by whistleblowers and investigated and resolved by federal and state prosecutors. The lawsuits alleged that for more than five years, Walgreens falsely certified that it had complied with diagnosis-related requirements for the lawful dispensing of prescriptions to Medi‑Cal patients. Through the Bureau of Medi‑Cal Fraud and Elder Abuse (BMFEA), the Attorney General’s office regularly works with whistleblowers and law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi‑Cal program. False claims lawsuits pursued by the Attorney General in the last two years have recovered tens of millions of dollars from some of the nation’s largest pharmaceutical companies for allegations of improper marketing, falsifying reports to inflate prices, and other wrongful practices. CA

Tagged in: FCA State, Lack of Medical Necessity, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

March 13, 2017

Massachusetts-based Charles River Laboratories International Inc. agreed to pay $1.8 million to settle claims it violated the False Claims Act by improperly charging for labor and other associated costs not actually provided on certain National Institutes of Health contracts relating to the provision of laboratory animals to the NIH. DOJ

Tagged in: Anti-Kickback and Stark, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

March 6, 2017

Simon Hong, owner of Los Angeles-based JH Physical Therapy Inc., was sentenced to 63 months in prison and to pay roughly $2.4 million in restitution, for his role in a $3.4 million Medicare fraud scheme that involved billing for occupational therapy services that were not medically necessary and not provided. Hong admitted billing Medicare for occupational therapy services when what were provided instead were acupuncture and massage services, not reimbursable by Medicare. Hong further admitted directing co-conspirator therapists to falsify medical records to make it appear as if the services billed actually had been provided. DOJ

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

February 24, 2017

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc., two Miami-area home health agencies, was sentenced to a 126 month prison term for his role in a $2.5 million Medicare fraud scheme. The evidence at trial showed that Leon and his co-conspirators used the companies to submit false claims to Medicare based on services not medically necessary, not actually provided, and for patients procured through the payment of illegal kickbacks to doctors and patient recruiters. DOJ

Tagged in: Anti-Kickback and Stark, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

February 10, 2017

Dr. Paul B. Tartell, an ENT physician practicing in Plantation, Florida and his practice Paul B. Tartell, M.D., P.L., have agreed to pay $750,000 to resolve allegations that he violated the False Claims Act by billing for surgical endoscopies with debridement and laryngeal stroboscopies that were not provided or not medically necessary. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Theodore Duay, a former patient of Dr. Tartell. Mr. Duay will receive a whistleblower award of $135,000 from the proceeds of the government's recovery. DOJ (SDFL)

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

February 7, 2017

Florida physician Gary L. Marder, and the owner of the Allergy, Dermatology & Skin Cancer Centers in Port St. Lucie and Okeechobee, stipulated to a consent final judgment of over $18 million to settle False Claims Act allegations that Dr. Marder submitted claims to federal healthcare programs for medically unnecessary biopsies and radiation therapy services, radiation therapy services performed in contravention of standard practice regarding the amount of time between radiation treatments, and radiation therapy services performed without direct supervision and by unlicensed and/or unqualified physician assistants. Dr. Kendall also allegedly submitted false claims to federal and state healthcare programs for laboratory services tainted by kickbacks to, and improper financial relationships with, Dr. Marder. The allegations originated in a whistleblower lawsuit filed by Dr. Theodore A. Schiff under the qui tam provisions of the False Claims Act. He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (SDFL)

Tagged in: FCA Federal, Lack of Medical Necessity, Medicaid, Medicare, Whistleblower Case, Whistleblower Rewards,

February 2, 2017

Pain management physician Dr. Robert Windsor, owner of National Pain Care, Inc. which owns pain management clinics in Georgia and Kentucky, agreed to the entry of a $20 million consent judgment to resolve allegations he violated the False Claims Act by billing federal health care programs for surgical monitoring services he did not perform and for medically unnecessary diagnostic tests. The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Kris Frankenberg, Stephanie Herder and Bradley Davis. They will receive a yet-to-be-determined whistleblower award from the proceeds of the government’s recovery. Whistleblower Insider

Tagged in: FCA Federal, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

February 1, 2017

Florida urologist Dr. Meir Daller agreed to pay $3.81 million to resolve allegations he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary. Dr. Meir practices as part of Gulfstream Urology, a division of 21st Century Oncology, LLC, which is a nationwide provider of integrated cancer care services. The government previously entered into settlements relating to similar allegations with 21st Century Oncology for $19.75 million and urologists David Spellberg and Robert Scappa for $1,050,000 and $250,000, respectively. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Mariela Barnes, a former medical assistant for Dr. Spellberg at Naples Urology Associates, also a division of 21st Century Oncology. She will receive a whistleblower award of $571,500 from the proceeds of the government's recovery in this settlement. This is in addition to a $3,437,000 million award she already received from the prior settlements. DOJ (MDFL)

Tagged in: FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

January 27, 2017

Brooklyn residents Olga Proskurovsky, Yuriy Omelchenko and Isak Aharanov pleaded guilty in connection with a health care fraud scheme involving two Brooklyn clinics that caused approximately $55 million in false claims to Medicare and Medicaid. They agreed to forfeiture money judgments in the amount of roughly $17 million. Proskurovsky served as a medical biller and Omelchenko worked as a therapist manager at Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. where they assisted in a scheme to defraud the Medicare and Medicaid programs in which patients subjected themselves to medically unnecessary health services, including physical and occupational therapy, provided by unlicensed staff. DOJ

Tagged in: Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare,

Contact

Click here for a confidential contact or call: