Archive

May 3, 2021

Two medical device distributorships, Medical Designs LLC and Sicage LLC, and their neurosurgeon owner, Wilson Asfora, have agreed to pay $4.4 million to resolve allegations of illegally inducing the use of certain medical devices, submitting false claims to federal healthcare programs for medically unnecessary procedures, and failing to disclose Asfora’s ownership interests or illegal payments made to him. The settlement was not the first involving Asfora; the United States previously settled with Sanford Health for $20.25 million and Medtronic for $9.21 million on similar claims. The whistleblowers in this case, Drs. Carl Dustin Bechtold and Bryan Wellman, will receive a $800,000 share of the settlement proceeds, while the defendants will all be excluded from participating in federal healthcare programs for six years. DOJ; USAO SD

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

April 30, 2020

CareCloud Health, Inc. has agreed to pay $3.8 million to settle kickback allegations involving sales of its electronic health records (EHR) software products and related services. In a qui tam suit filed by Ada de la Vega, the whistleblower alleged that between 2012 and 2017, CareCloud offered and provided existing clients improper incentives, including cash bonuses and equivalent credits, to recommend their product to prospective clients. For her role in the successful enforcement action, de la Vega will receive a relator’s share of over $800,000. USAO SDFL

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

April 29, 2021

Over two dozen defendants who were part of an extensive prescription drug fraud scheme involving Alabama-based Northside Pharmacy d/b/a Global Compounding Pharmacy have been sentenced to prison. The defendants included company executives and managers, prescribers, billers, and sales representatives who, between 2013 and 2016, billed insurers such as Medicare and TRICARE for massive quantities of medically unnecessary prescription drugs. In just that short period of time, the defendants caused insurers to pay nearly $50 million in medically unnecessary claims, with more than $13 million arising from improper payments to prescribers, and more than $8.4 million for prescriptions written out to Global employees themselves. USAO NDAL

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs,

April 27, 2021

Indivior plc and Indivior Inc., will pay $300 million to settle claims from all 50 states, the District of Columbia, and Puerto Rico, alleging they caused the misuse of state Medicaid funds by falsely marketing the drug Suboxone. Suboxone is used by recovering opioid addicts to reduce withdrawal symptoms. According to the governments, Indivior promoted the sale and use of Suboxone for unsafe, ineffective, and medically unnecessary purposes, including by claiming it was less susceptible to abuse even though the active ingredient, buprenorphine, is a powerful opioid itself. Additionally, the company took steps to fraudulently delay the entry of generic alternatives in order to control pricing. The settlement resolves six whistleblower suits pending in New Jersey and Virginia. Indivior previously paid $600 million to resolve federal claims, and former parent company Reckitt Benckiser previously paid $1.4 billion to resolve the same. CA AG; FL AG; MI AG

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Misrepresentations, Whistleblower Case,

April 23, 2021

Bobby Rouse, a former executive with Continuum Healthcare LLC, which owned Houston hospital Westbury Community Hospital as well as area mental health centers, was sentenced to ten years in prison following his guilty plea on charges arising from an unlawful kickback scheme. At the direction of Rouse and co-conspirators, Continuum paid kickbacks for the referral of patients to partial hospitalization programs at Continuum facilities, many of whom did not qualify for PHP services. In total, Continuum billed Medicare approximately $189 million for fraudulent PHP services, and Medicaid paid approximately $66 million on those clams. Fourteen individuals have been charged for the fraud. USAO SD TX

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Hospital Fraud,

April 21, 2021

Tennessee-based Anesthesia Services Associates, PLLC d/b/a Comprehensive Pain Specialists (CPS) and its four majority owners have agreed to pay a total of $4.1 million to resolve allegations of violating the federal False Claims Act and Tennessee Medicaid False Claims Act. According to the government, CPS billed Medicare and TennCare for medically unnecessary or non-reimbursable genetic tests, psychological tests, specimen validity tests, and urine drug tests, as well as medically unnecessary or non-reimbursable acupuncture. For bringing a successful qui tam suit, the whistleblowers in this case will receive a relator’s share of over $610,000. USAO MDTN

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 20, 2021

In order to resolve a whistleblower suit alleging violations of the False Claims Act, Massachusetts Eye and Ear and its related entities have agreed to pay over $2.6 million. Over an eight-year period ending in 2020, Massachusetts Eye and Ear allegedly made a habit of submitting false claims to Medicare and Medicaid for office visits that were not reimbursable under program rules. Altogether, the government programs were defrauded of over a million dollars. As a reward for blowing the whistle, the unnamed relator will receive a 15% share of the settlement proceeds. USAO MA

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

April 19, 2021

Maryland physician Njideka Udochi of Millennium Family Practice will pay $660,000 to resolve allegations that she submitted false claims for auricular stimulation, or "P-Stim," devices. Udochi billed Medicare using a billing code covering the surgical implantation of a type of neurostimulator, but P-Stim devices are not surgically implanted, and are not approved for reimbursement from Medicare. USAO MD

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Provider Fraud, Upcoding,

April 14, 2021

The owner of a Florida-based telemarketing call center, Ivan Andre Scott, has been sentenced to 10 years in prison after being convicted of conspiracy to commit healthcare fraud in connection with a $3.3 million fraud scheme against Medicare. According to evidence presented at trial, Scott made telemarketing calls to Medicare beneficiaries to persuade them to take expensive genetic tests, paid illegal kickbacks to telemedicine companies in exchange for doctor authorizations, and received illegal kickbacks from laboratories in exchange for providing them with the genetic tests. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare,

April 13, 2021

After pleading guilty to one count of conspiracy to commit healthcare fraud, James Spina of Dolson Avenue Medical (DAM) in New York has been sentenced to 9 years in prison and ordered to pay over $9.7 million in restitution and over $9.1 million in forfeiture. Because he did not meet legal requirements for owning and operating a medical corporation, Spina went to great lengths to conceal his role in DAM and at least four other medical corporations, which he then used to run a widespread fraud scheme against Medicare and other health insurers. The misconduct involved submitting fraudulent claims for medically unnecessary services and services not rendered, double billing for services, fabricating medical records, and obstructing audits by Medicare and other health insurers. USAO SDNY

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

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