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Page 27 of 71

February 26, 2020

The two owners and operators of Royal Care Pharmacy in Los Angeles have been ordered to pay restitution of $11.8 million to Medicare and $17,000 to Cigna after being found guilty of healthcare fraud and money laundering.  Aleksandr Suri and Maxim Sverdlov were also sentenced to 12 years in prison.  From 2012 to 2015, the two had fraudulently billed Medicare and Cigna for prescription medications that were not purchased or dispensed to beneficiaries, hiding the conspiracy and laundering the proceeds through fake invoices.  DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Medicare, Pharma Fraud,

February 19, 2020

Guardian Elder Care Holdings, Inc. has agreed to pay $15.5 million to settle claims of defrauding Medicare and Medicaid.  In a qui tam suit filed in 2015, whistleblowers Philippa Krauss and Julie White alleged that from 2011 to 2017, the Pennsylvania-based nursing home chain pressured its therapists to provide medically unnecessary rehabilitation to patients suffering from dementia or dying in hospice care in order to boost its profits.  During the subsequent government investigation, Guardian Elder Care self-disclosed that it had also billed federal healthcare programs for services performed by two excluded individuals.  As part of the settlement, Guardian Elder Care has entered into a chain-wide Corporate Integrity Agreement with the Department of Health and Human Services, and Krauss and White will split a $2.8 million relator's share.  USAO EDPA; USAO WDPA

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

February 14, 2020

Tennessee-based Cookeville Regional Medical Center Authority (CRMC) has agreed to pay $4.1 million to settle allegations of violating the Anti-Kickback Statute, Stark Law, and False Claims Act from 2012 to 2017.  In a qui tam suit that initiated the investigation, an unnamed whistleblower alleged that CRMC submitted claims to Medicare and TennCare that arose from improper financial arrangements with physicians at its wholly owned subsidiary, CRMC MSO-Sub 1, Inc., d/b/a Tennessee Heart.  $3.6 million of the settlement proceeds will go to the United States, $453,000 will go to the State of Tennessee, and $779,000 will go to the whistleblower.  USAO MDTN

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

February 12, 2020

A neurosurgeon accused of receiving illegal kickbacks from distributors of spinal implant devices has agreed to pay $2.35 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  While practicing at three Colorado area hospitals, Dr. William Choi created distributorships Nexus Spine, LLC and 4D Spine, LLC to provide spinal implant equipment for surgeries he performed.  Despite naming third parties as the registered owners, Dr. Choi maintained control of the distributorships and their profits, thus soliciting and receiving improper payments from these entities.  His fraudulent conduct was eventually revealed by a former 4D employee, Mark Rahe, who filed the civil action.  USAO CO

Tagged in: Anti-Kickback and Stark, FCA Federal, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

February 11, 2020

Tenet Healthcare Corporation and its affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.4 million to settle allegations that they knowingly charged Medicare for medically unnecessary cardiac monitors, in violation of the False Claims Act.  According to former DRMC employee, Michael Grace, the devices were implanted between 2014 to 2017, exposing beneficiaries to unnecessary risk and causing the government unnecessary expenses.  For exposing the fraud, Grace will receive a $240,789 share of the recovery.  DOJ

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

February 6, 2020

A patient recruiter in Kentucky has been sentenced to 5 years in prison and ordered to pay or forfeit over $1.2 million in total for accepting more than $1 million in kickbacks from home health agencies in exchange for providing information about Medicare beneficiaries.  The owner of Trumbo Consulting Agency in Virginia, Dominic Trumbo recruited and paid others to recruit over 4,000 Medicare beneficiaries for home health services by offering incentives to get them to sign up.  Trumbo then sold the information to home health agencies around the country in exchange for kickbacks, then created fake contracts and invoices to conceal the fraud from Medicare.  DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

February 4, 2020

Psychotherapy, adolescent therapy, and tutoring company The Center of Attention, LLC: No One Left Behind, together with its owner Selina Christian, will pay $200,000 and be suspended from Connecticut's Medicaid program, based on allegations that defendants violated the Connecticut False Claims Act and submitted false claims for services that were either never provided, or that were for non-psychotherapy services that were not covered by Medicaid.  CT

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

February 4, 2020

Southeastern Retina Associates (SERA), which operates in parts of Tennessee, Georgia, and Virginia, has agreed to pay $1.5 million and enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services for allegedly defrauding Medicare and Medicaid.  The investigation was launched by a qui tam suit filed by an unnamed whistleblower, which alleged that between 2009 to 2016, the practice improperly billed exams at a higher rate than appropriate, and used a billing code called Modifier 25 to bill for exams that were not separately billable from other services billed the same day.  For exposing the misconduct, the relator in this case will receive a $270,000 share of the settlement.  USAO EDTN

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

February 3, 2020

Senthil Kumar Ramamurthy of Texas has been sentenced to 10 years in prison for participating in two fraud schemes that amounted to $9.6 million in losses by Medicare and TRICARE.  In the first scheme, which ran for 10 months in 2014, Ramamurthy and his co-conspirators were paid millions of dollars by compounding pharmacies to get TRICARE beneficiaries to sign up for medically unnecessary compounded prescription drugs.  To get beneficiaries to sign up, defendants had falsely represented that the drugs would be free, when in fact co-payments were required.  In the second scheme, which ran from 2015 onward, Ramamurthy and his co-conspirators paid doctors to refer Medicare beneficiaries—without first examining them—for needless genetic cancer screening tests.  Many of Ramamurthy's co-conspirators have plead guilty and face sentencing later this month.  USAO SDFL

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Criminal Proceedings, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

January 29, 2020

A Florida-based physician, Erik Schabert, and his ex-wife, Mika Harris, have been sentenced to 3.5 years and 3 months in prison, and ordered to pay almost $4.5 million in restitution to Blue Cross Blue Shield for attempting to defraud the insurer and the Medicare program of more than $8 million.  Between 2013 and 2016, the two owners and operators of Reliant Family Practice falsely diagnosed actinic keratosis and rosacea in order to make fraudulent claims for chemical peels and dermabrasions.  Along with prison time and restitution, the two have forfeited their private residence, commercial property, and over $260,000 in an annuity account, to the federal government.  USAO NDFL

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

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