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April 5, 2018

The Estate of Dr. Leroy Pelicci, former owner of Scranton-based Pelicci Pain Relief Center, agreed to pay $625,000 to settle claims he violated the False Claims Act by submitting improper claims for payment to the Department of Labor Office of Workers’ Compensation Programs under the Federal Employees Compensation Act and the Federal Employees Health Benefits Program for trigger point injections, which were upcoded to receive a higher reimbursement amount than permitted. DOJ (MDPA)

Tagged in: Healthcare Fraud, Other Government Health Programs, Provider Fraud, Upcoding,

March 29, 2018

Georgia Bone & Joint, Southern Bone & Joint (a/k/a Summit Orthopaedic Surgery Center), Southern Crescent Anesthesiology, PC, Sentry Anesthesia Management, LLC, and David LaGuardia agreed to pay $3.2 million to settle claims they violated the False Claims Act and Anti-Kickback Statute. Specifically, the government alleged that LaGuardia, Sentry, and Southern Crescent provided a free medical director to Summit Surgery Center to induce it to choose to perform more procedures at the surgery center rather than in the Georgia Bone office. The government further alleged that Georgia Bone and LaGuardia caused the submission of false claims to Medicare for prescription drugs purchased outside the United States and not approved by the FDA. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Sharon Kopko, former Practice Administrator for Southern Bone. She will receive a yet-to-be determined award from the proceeds of the government’s recovery. DOJ (NDGA)

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

March 29, 2018

Texas-based SightLine Health LLC, which operates radiation therapy centers throughout the United States, agreed (together with its parent Oncology Network Holdings) to pay up to $11.5 million settle claims  it violated the False Claims Act and Anti‑Kickback Statute. According to the government, SightLine targeted physicians that were able to refer patients to its cancer treatment centers, and paid those physicians a share of its profits. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive an award of up to $1.725 million from the proceeds of the government’s recovery. DOJ

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

March 28, 2018

Medical Transport LLC, a Virginia Beach-based provider of ambulance services, agreed to pay $9 million to resolve allegations it violated the False Claims Act by submitting claims for ambulance transports not medically necessary, that did not qualify as Specialty Care Transports, and that were billed improperly to the federal health care programs when they should have been billed to other payers. DOJ

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

March 16, 2018

Four Maryland healthcare providers settled claims they violated the False Claims Act by improperly coding for certain medical tests they billed to Medicare: St. Agnes Healthcare, Inc., which owns and operates St Agnes hospital in Baltimore, agreed to pay roughly $70,000; Horizon Vascular Specialists agreed to pay roughly $518,000; Riverside Medical Associates agreed to pay roughly $177,000; and Maryland Specialty Group agreed to pay roughly $87,000.  Dr. Itsuro Uchino agreed to pay roughly $91,000. DOJ (MD)

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud, Provider Fraud,

March 13, 2018

Marshfield Medical, Inc. (formerly known as Bromedicon, Inc.) agreed to pay $550,000 to settle claims it violated the False Claims Act for submitting claims to Medicare and other federal health care programs without providing a qualified interpreting physician to monitor each surgery for which it purportedly provided remote Intraoperative Neurophysiological Monitoring. According to the government, in some of those cases, no one monitored the data stream from the surgeries and in others, Bromedicon’s medical director, a foreign medical school graduate with no license to practice medicine in the United States, was the only monitor. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  DOJ (EDPA)

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

March 7, 2018

UPMC Hamot, affiliated with the University of Pittsburgh Medical Center, and Medicor Associates Inc., a regional physician cardiology practice, agreed to pay $20.7 million to settle charges of violating the False Claims Act, Anti‑Kickback Statute and Stark Law through Hamot's payment under twelve physician and administrative services arrangements to secure Medicor patient referrals. Hamot allegedly had no legitimate need for the services contracted for, and in some instances the services either were duplicative or were not performed. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Medicor employee Dr. Tullio Emanuele. He will receive a whistleblower award of roughly $6 million from the proceeds of the government's recovery. DOJ

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

March 7, 2018

Florida dermatologist and owner of Treasure Coast Dermatology agreed to pay $2.5 million to settle claims he violated the False Claims Act by billing Medicare and TRICARE for procedures he did not perform.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Patricia Cleary, a former patient of Dr. Ioannides. She will receive a whistleblower award of $475,000 from the proceeds of the government’s recovery. DOJ (SDFL)

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

March 6, 2018

Iowa chiropractor Bradley Brown and his clinic Brown Chiropractic, P.C. agreed to pay roughly $80,000 to settle claims they violated the False Claims Act and Anti-Kickback Statute by billing Medicare and Medicaid for chiropractic adjustments after providing free electrical stimulation to beneficiaries to influence those beneficiaries to receive chiropractic adjustments from Brown. DOJ (NDIA)

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

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