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Page 28 of 79

June 11, 2019

A physical therapy center, its owner, and four nursing facilities in the Chicago area have settled an intervened qui tam suit that alleged that they upcoded patient Resource Utilization Group (RUG) scores, in violation of the False Claims Act, in order to increase Medicare payments.  Quality Therapy & Consultation Inc and owner Francise Parise allegedly worked in conjunction with Carlton at the Lake Inc, Ridgeview Rehab and Nursing Center, Lake Shore Healthcare and Rehabilitation Centre LLC, and Balmoral Home Inc to manipulate the RUG scores, which indicate the level of skilled nursing care each patient requires.  By upcoding the scores, the defendants allegedly claimed higher reimbursement rates from Medicare.  As part of the settlement, each of the facilities will pay between $1 and $4 million, and Parise will pay $160,000, for a combined recovery of $9.7 million.  USAO NDIL

Tagged in: FCA Federal, Healthcare Fraud, Medicare, SNF, Upcoding, Whistleblower Case,

May 31, 2019

Oklahoma Heart Hospital, LLC and Oklahoma Heart Hospital South, LLC (collectively “OHH”), have agreed to pay $2.8 million to resolve a qui tam suit by a former employee, which alleged that OHH violated the federal and state False Claims Acts and defrauded Medicaid by submitting claims for outpatient procedures as if they were inpatient procedures.  Though multiple allegations were raised in the lawsuit, only the allegation involving the upcoded claims was intervened by the government; the other allegations will be dismissed as part of the settlement.  USAO WDOK

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Upcoding, Whistleblower Case,

May 30, 2019

HyperHeal Hyperbarics, an oxygen therapy facility in Maryland, has agreed to pay over $400,000 to settle whistleblower allegations filed under the False Claims Act.  In their 2016 qui tam suit, former employees Lesa Schrum and Juliette Skelton alleged that from 2013 to 2014, HyperHeal and its part-owner Eric Shapiro billed TRICARE for medically unnecessary services, services performed without physician supervision, or services that weren't ever performed.  As part of the settlement, Schrum and Skelton will receive $74,635.25.  USAO MD

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

May 30, 2019

Joseph P. Galichia, a cardiologist in Wichita, Kansas, will pay $5.8 million to resolve allegations under the False Claims Act that he and his practice, Galichia Medical Group, P.A., implanted cardiac stents in patients who did not need them, and billed Medicare, the Defense Health Agency, and the Federal Employees Health Benefits Program for these medically unnecessary procedures. Galichia will also be excluded from participating in federal healthcare programs for three years. The case was initiated by a whistleblower, Aly Gadalla, M.D., who filed a qui tam complaint.  Dr. Gadalla will receive a whistleblower reward of $1.16 million.  This is the third time Galichia had settled FCA claims against him and his practice. DOJ; USAO Kan

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

May 17, 2019

Dr. Donald Douglas, the physician owner of three healthcare clinics in Texas, has agreed to pay $118,000 to resolve allegations of improperly billing Medicare at the physician rate for services performed by advance practice nurses (“APNs”) without direct physician supervision.  Under Texas law, APN-provided services performed with physician supervision may be billed to Medicare at the full physician rate.  USAO EDTX

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

May 9, 2019

Carolina Physical Therapy and Sports Medicine, Inc. agreed to pay $790,000 to settle a whistleblower lawsuit alleging the company knowingly submitted false claims to Medicare and TRICARE. According to former employee Hilary Moore, Carolina PT submitted claims for group physical therapy services that were billed as though they were one-on-one sessions. Additionally, claims for certain services performed by physical therapy assistants were billed as though they were performed under the supervision of qualified therapists. For exposing the fraudulent conduct, Moore will receive a relator’s share of $142,200.  USAO SC

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

May 9, 2019

Paul J. Mathieu and Hatem Behiry were found guilty for their part in a $30 million scheme to defraud Medicare and the New York State Medicaid program. Between 2007 and 2013, Mathieu falsely posed as an owner of three medical clinics (the “Clinics”) in Brooklyn. During that time, the Clinics fraudulently billed Medicare and Medicaid for medical services and supplies that were not necessary, or were not even provided. Furthermore, Mathieu did not see any patients at that time. Instead, he falsified large stacks of bogus medical records in which he stated that he did see and treat those patients. Behiry, a physical therapy doctor, also participated in the Clinic’s fraudulent billing practices by pretending to provide physical therapy services to patients. Mathieu and Behiry have not yet been sentenced. DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare,

May 8, 2019

Tea Kaganovich and Ramazi Mitaishvili, co-owners of New York Diagnostic Testing Centers, each pleaded guilty to health care fraud and conspiracy to defraud the lawful functions of the Internal Revenue Service (IRS). The couple submitted false health care claims for diagnostic testing services and paid over $18 million in kickbacks for the referral of beneficiaries who signed up for diagnostic testing and other alleged medical services. They fraudulently reported to the IRS that the illegal kickback payments were valid business expenses, thus causing relevant tax forms to under-report business income and claim deductions. DOJ

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

May 6, 2019

Acadia Healthcare Company, Inc., which operates outpatient drug treatment centers in West Virginia through its subsidiary CRC Health, L.L.C., will pay $17 million to resolve claims that it improperly billed the state's Medicaid program for urine and blood testing services as if they had performed the testing themselves, despite the fact that Acadia lacked the certification to perform the tests.  In fact, the testing was performed by an independent outside laboratory, and that lab independently billed Medicaid for the tests, at a lower rate. Medicaid paid Acadia’s treatment centers $8,500,000 for the improperly-billed tests.  As part of this settlement, defendants also entered into a five-year corporate integrity agreement to maintain specified compliance programs and procedures.  USAO SDWV

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud,

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