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December 14, 2017

Texas-based DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with severe kidney disease, agreed to pay $63.7 million to resolve charges of violating the False Claims Act by billing Medicare for prescription medications never shipped, shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent. The settlement also resolves allegations that DaVita paid financial inducements to Medicare beneficiaries in violation of the Anti-Kickback Statute. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by two former DaVita employees Patsy Gallian and Monique Jones. The whistleblowers will receive an award of $2.1 million from the proceeds of the government's recovery. DOJ

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

December 12, 2017

Florida-based 21st Century Oncology Inc. agreed to pay $26 million to settle charges of violating the False Claims Act and the Stark Law through the company’s false attestation to the use of electronic health records software and through referrals from physicians with whom the company had improper financial relationships. DOJ

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Provider Fraud,

December 12, 2017

Mobile imaging companies PDQ Imaging Services, LLC, PDQ Ultrasound Services, LLC, PDQ Mobile X-Ray Services, PDQ Mobile X-Ray, LLC, along with their owners Dennis Whitsell and Jonathan Graham Lane, agreed to pay $300,000 to settle charges of violating the False Claims Act and Anti-Kickback Statute by improperly billing Medicare for transportation charges related to portable x-ray services and paying kickbacks to skilled nursing facilities in exchange for patient referrals. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Kevin P. McDonough and Boyd K. Billington. They will receive a whistleblower award of roughly $60,000 from the proceeds of the government's recovery. DOJ (EDTX)

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

December 11, 2017

Yunesky Fornaris, the owner and operator of defunct Miami home health agency Elite Home Care, was sentenced to 115 months in prison and to pay $15.1 million in restitution for his role in a $15 million conspiracy to defraud the Medicare program through the enlisting of patient recruiters to recruit patients to Elite in exchange for illegal bribes and kickbacks. DOJ

Tagged in: Anti-Kickback and Stark, Home Health and Hospice,

December 1, 2017

Pine Creek Medical Center LLC, a physician-owned hospital serving the Dallas/Fort Worth area, agreed to pay $7.5 million to resolve claims it violated the False Claims Act and Anti-Kickback Statute by paying physicians kickbacks in the form of marketing services in exchange for surgical referrals.  Specifically, Pine Creek allegedly paid for advertisements on behalf of the physicians as well as radio and television advertising, pay-per-click advertising campaigns, billboards, website upgrades, brochures, and business cards, and other forms of marketing to induce physicians to refer patients to Pine Creek for medical services.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former Pine Creek employees Suzanne Scott and Savannah Sogar.  They will receive a whistleblower award of $1,125,000 from the proceeds of the government's recovery.  DOJ

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

November 17, 2017

Meadows Regional Medical Center, Inc. agreed to pay up to $12,875,000 to resolve allegations of violating the False Claims Act, Anti-Kickback Statute and Stark Law by submitting claims referred by physicians with whom Meadows had improper compensation arrangements.  DOJ (SDGA)

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

November 16, 2017

Four San Diego-area nursing homes owned by Los Angeles-based Brius Management Co. agreed to pay as much as $6.9 million to resolve allegations of violating the False Claims Act and Anti-Kickbacks Statute by paying kickbacks for patient referrals to discharge planners at Scripps Mercy Hospital San Diego.  The four nursing homes involved are Point Loma Convalescent Hospital, Brighton Place – San Diego, Brighton Place – Spring Valley, and Amaya Springs Health Care Center.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Viki Bell-Manako, a former employee of one of the Brius nursing homes.  She will receive a whistleblower award of 20% of the proceeds of the government's recovery.  DOJ (CDCA)

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

October 20, 2017

Jacksonville-based toxicology lab Total Lab Care, LLC agreed to pay $212,500 to resolve allegations it violated the False Claims Act and Anti-Kickback Statute by improperly paying a physician for referring toxicology samples.  DOJ (MDFL)

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF,

October 4, 2017

Four Houston-area hospitals agreed to pay $8.6 million to settle allegations they violated the False Claims Act and Anti-Kickback Statute by receiving kickbacks from various ambulance companies in exchange for rights to the hospitals’ more lucrative Medicare and Medicaid transport referrals.  The hospitals are all affiliated with Nashville-based Hospital Corporation of America include Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center and East Houston Regional Medical Center.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive an award from the proceeds of the government's recovery. DOJ (SDTX)

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

September 15, 2017

Valentina Kovalienko, the owner of Brooklyn medical clinics Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. was sentenced to 84 months in prison and ordered to forfeit roughly $29 million for her role in a $55 million health care fraud scheme.  As part of her guilty plea, Kovalienko acknowledged that her co-conspirators paid cash kickbacks to patients to induce them to attend her two clinics.  She also admitted submitting false and fraudulent claims to Medicare and Medicaid for services that were induced by prohibited kickback payments to patients or that were unlawfully rendered by unlicensed staff. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Improper Medical Personnel, Provider Fraud,

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