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January 23, 2020

Arch Health Partners, Inc. has agreed to pay $2.9 million to resolve fraud allegations brought by a former employee turned whistleblower, Catherine Jones.  Jones alleged in a qui tam suit that the San Diego-based healthcare provider had falsely billed Medicare for evaluation and management services that lacked sufficient documentation, in violation of the False Claims Act.  Based on self-disclosures by Arch Health, the United States also alleged that referring physicians were being compensated above fair market value, in violation of the Anti-Kickback and Stark Acts.  Jones will receive $183,830 of the settlement proceeds.  USAO SDCA

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

January 16, 2020

Udaya Shetty, a psychiatrist in Virginia, was sentenced to over two years in prison and has agreed to pay over $1 million to the United States and the Commonwealth of Virginia to resolve allegations of submitting false claims to Medicare, Medicaid, and TRICARE.  Shetty was accused of billing for services that average about 40-60 minutes long, despite quadruple booking patients and only seeing them for about 5-10 minutes each.  The scheme began at his own practice, Behavioral & Neuropsychiatric Group, in 2013, and continued at a new practice, Quietly Radiant Psychiatric Services, in 2017.  As a result of his actions, government health programs were defrauded of more than $450,000.  USAO EDVA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs,

January 15, 2020

ResMed Corp. has agreed to pay $37.5 million to resolve five whistleblower-brought lawsuits alleging that the durable medical equipment (DME) manufacturer paid illegal kickbacks to suppliers, sleep labs, and other health providers, in violation of the Anti-Kickback Statute and False Claims Act.  $6.2 million of the settlement will be split amongst the whistleblowers, who had revealed that ResMed improperly provided or helped provide free or below cost call center services, patient outreach services, medical equipment and installation, and interest-free loans, in exchange for business.  DOJ; USAO EDNY; USAO NC; USAO NDIA; USAO SC; USAO SDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

January 15, 2020

TMJ & Orofacial Pain Treatment Centers of Wisconsin has agreed to pay $1 million to settle a qui tam suit alleging submissions of false claims to Medicare and TRICARE.  According to the anonymous whistleblower, who will receive an undisclosed share of the settlement, TMJ billed the government health programs for prosthetic devices as if they had been fabricated by in-house surgeons, when in fact they had been fabricated by an outside laboratory.  USAO EDWI

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs, Provider Fraud, Upcoding, Whistleblower Case,

January 10, 2020

The owner of two Philadelphia-based testing laboratories has pleaded guilty and agreed to pay more than $77 million in restitution for participating in an illegal kickback scheme.  At his plea hearing, Ravitej Reddy admitted that his laboratories, Personalized Genetics, LLC and Med Health Services Management, LP, participated in a fraudulent scheme that took advantage of the labs' location in a high reimbursement area for Medicare cancer and pharmacogenetic testing the labs actually sent for testing to a laboratory that was located outside of the lucrative coverage area, because the labs lacked equipment to perform the tests themselves.  To secure the lab orders, Reddy admitted paying kickbacks to co-conspirators, including marketers that solicited specimens from Medicare beneficiaries, and a telemedicine practice that improperly authorized the tests without regard to medical necessity.  In addition to the restitution order, Reddy faces a maximum of 25 years in prison at his sentencing in February.  USAO WDPA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

January 7, 2020

Behavioral Consulting of Tampa Bay (BCOTB) has agreed to pay $675,000 to settle claims alleging the autism service provider submitted false or fraudulent claims to TRICARE.  Following an audit by TRICARE's managed care support contractor, the United States launched an investigation into BCOTB's claims that revealed it had misrepresented the services that were provided, misrepresented the identity of service providers, requested payment on more units of time than reflected by records, and requested payment on services that were not substantiated by records.  USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Misrepresentations, Other Government Health Programs, Provider Fraud,

January 6, 2020

A now defunct behavioral health clinic, Tree of Life, Inc., and its owners and operators, Ada and Victor Vidal, have agreed to pay $1.65 million to settle a whistleblower's claims that they violated the False Claims Act and Anti-Kickback Statute in claims to Pennsylvania's Medicaid program.  According to Erika Desjardins, the former Clinical Director, Tree of Life billed for therapy sessions where either the patient or therapist could not possibly have attended (in some cases due to a patient’s hospitalization or death), as well as therapy sessions provided by unqualified individuals.  To facilitate the fraud scheme, it created fake records, including forged signatures, and improperly paid a social worker for patient referrals.  As part of the settlement, the Vidals have been excluded from future participation in federal healthcare programs, and Desjardins, who had been fired for reporting internally, will receive $330,000 as their share of the recovery.  USAO EDPA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 30, 2019

A defense contractor accused of submitting false claims on a contract with the U.S. Army has agreed to pay $3 million to resolve its liability.  Kansas-based LaForge & Budd Construction Company, Inc., had been tasked with raising the elevation of a dam at the Fort Sill Army Post in Oklahoma.  Although the contract specified that satisfactory fill be used, LaForge defied this by using materials such as pieces of concrete, rebar, and rubble, and then represented to the Army that it had fully complied with the contract's terms and conditions.  USAO WDOK

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare,

December 30, 2019

Medsurant Holdings, LLC, the nation's largest independent provider of Interoperative Neuromonitoring (IONM) services, has agreed to pay $1.9 million to settle allegations of defrauding Medicare.  According to the DOJ, from 2013 to 2016, Medsurant billed Medicare for IONM services—used to monitor patients’ nervous systems during high-risk surgeries—that were not provided exclusively to one patient or were concurrently provided to patients insured by private payors, in violation of Medicare rules as well as the False Claims Act.  USAO MDTN

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

December 19, 2019

Five individuals have been sentenced for their roles in a scheme to defraud TRICARE through the submission of false and fraudulent claims for compounded prescription pain creams.   Marketing firm Centurion Compounding, Inc., owned by  Frank Monte and Kimberley Anderson, entered into an agreement with LifeCare Pharmacy, owned by Carlos Mazariegos and Benjamin Nundy, to pay kickbacks to Dr. Anthony Baldizzi in exchange for him writing prescriptions for compounded creams marketed by Centurion to TRICARE beneficiaries. LifeCare billed health insurers, including TRICARE, more than $12.4 million for compounded cream prescriptions written by Baldizzi and marketed by Centurion, realizing a profit of more than $10 million, which it shared with Baldizzi, Monte, and Anderson.  Centurion also caused TRICARE to be billed additional fraudulent amounts through one or more other pharmacies.  Monte and Anderson of Centurion were sentenced to 2 years and 1.5 years, respectively, and Monte forfeited more than $3 million in property.  Baldizzi was sentenced to 1 year in prison, ordered to forfeit $100,000, and will surrender his license to practice medicine.  Mazariegos and Nundy of LifeCare were sentenced to 1 year in prison and 5 years probation, respectively, and paid over $12.8 million in restitution and forfeiture.  USAO MD FL

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Criminal Proceedings, Other Government Health Programs, Pharma Fraud,

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