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Page 29 of 79

May 3, 2019

Dr. Richard E. Paulus, an Ashland cardiologist, was sentenced to five years in prison for defrauding Medicare, Medicaid, and private insurers. Evidence showed that Paulus implanted medically unnecessary stents in his patients and falsified the degree of stenosis in their medical records. He has been charged with one count of health care fraud and ten counts of making false statements in regard to health care matters. In addition to time in prison, Paulus must also pay $1.1 million in restitution to Medicare, Medicaid, and other private insurers who were also victims of his financial scheme. DOJ

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

May 2, 2019

Chimes Delaware, which provides services to individuals with developmental disabilities in Delaware, will return $4.5 million in Medicaid funding to the state to resolve claims of billing errors in its supported employment programs and transportation services.  Chimes also agreed to institute new internal controls and billing procedures.  DE

Tagged in: Ambulance, Medicaid, Medical Billing Fraud, Provider Fraud,

April 30, 2019

The former CEO of hospital chain Health Management Associates LLC, Gary D. Newsome, has agreed to pay $3.46 million to resolve claims in a whistleblower lawsuit that he personally caused HMA to submit false claims to federal healthcare programs in violation of the False Claims Act.  Newsome was alleged to have caused HMA to pressure emergency department physicians to increase inpatient admissions without regard to medical necessity, so that the hospital chain could bill for more costly inpatient services.  In addition, Newsome was alleged to have caused HMA to make bonus payments to emergency department physicians, and contract concessions to the company, EmCare, that provided emergency department physician staffing, to increase inpatient admissions.  Newsome was the CEO from 2008 through 2013, prior to HMA's acquisition by Community Health Systems Inc.  HMA settled related claims in September 2018, and EmCare settled related claims in December 2017.  Two whistleblowers, Jacqueline Meyer, a former employee of EmCare, and J. Michael Cowling, a former employee of HMA, will receive approximately $725,000 from this settlement.  DOJ

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

April 30, 2019

Home healthcare company Avenue Homecare Services, Inc, of Dracut, Massachusetts, will pay $8.3 million to resolve allegations that between 2013 and 2016 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Avenue submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 30, 2019

Home healthcare company Amigos Homecare, LLC, of Lawrence, Massachusetts, will pay $2.13 million to resolve allegations that between 2014 and 2018 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Amigos submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 29, 2019

In Washington State, St. Joseph Medical Center of Tacoma, along with seven other hospitals of its parent company CHI Franciscan, have agreed to provide $22 million in debt forgiveness and refunds to patients who qualified for charity care but did not receive it, despite requirements that hospitals screen patients for charity care eligibility and provide notice of the availability of charity care.  WA AG

Tagged in: Hospital Fraud, Medical Billing Fraud,

April 24, 2019

Two executives of Arriva Medical, LLC, a mail-order diabetic testing supply company acquired by Alere, Inc. in 2011, will pay a total of $1 million to settle claims that they caused Arriva to submit false claims to Medicare by supplying patients with free or no cost home blood glucose meters, waiving patient copayments, and billing for medically unnecessary home blood glucose meters.  USAO MD TN;  2021 settlement with Arriva here

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME,

April 15, 2019

Cardiac Associates, P.C. will pay the United States over $399,000 to settle False Claims Act allegations related to improper billing practices. The U.S. contends that between January 1, 2012, and December 21, 2016, Cardiac Associates double billed for procedures on the same date for the one patient, when only one of the procedures was performed. Cardiac Associates also allegedly billed for two tests when testing patients for venous sufficiency, even though Medicare rules prohibit billing for both CPT 93970, the newer test, and CPT 93965, an older test using different technology. DOJ

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

April 9, 2019

A number of telemedicine and durable medical equipment companies, the principals of those companies, and three healthcare providers, were charged with submitting over $1.7 billion in false claims in a scheme to pay unlawful kickbacks and bribes from DME companies in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for medically unnecessary DME including back, shoulder, wrist and knee braces.  DOJ; USAO MD FL; USAO NJ; USAO SC.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Drug and DME Pricing, Lack of Medical Necessity, Provider Fraud,

April 5, 2019

Philip Esformes of Miami Beach, Florida, was found guilty of crimes arising from his role in the submission of over $1.3 billion in fraudulent claims to Medicare and Medicaid.  According to evidence introduced at trial, between 1998 and 2016, Esformes, who owned a network of assisted living and skilled nursing facilities, bribed physicians to admit patients into his facilities, which were in poor condition and unable to provide adequate treatment. Patients often failed to receive appropriate medical services, or received medically unnecessary services.  Esformes was later sentenced to 20 years in prison. USAO SD FL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Lack of Medical Necessity, SNF,

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