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October 3, 2022

Medical sales representative Steven Monaco has been sentenced to 14 years in prison for orchestrating two fraud schemes that led to multimillion dollar losses to federal, state, and private health insurance plans.  In the first scheme, Monaco arranged for a doctor’s medical assistant to be placed on the payroll of a medical diagnostic laboratory in exchange for all of the doctor’s labwork.  In the second scheme, Monaco arranged for doctors to sign medically unnecessary prescriptions for expensive compounded medications, on behalf of patients they never evaluated, in exchange for illegal kickbacks.  Monaco received $36,000 from the first scheme and $350,000 from the second scheme, and caused over $4.6 million in losses to the insurance plans.  USAO NJ

October 3, 2022

South Carolina-based Radeas, LLC has agreed to pay $3.6 million to settle allegations of submitting false claims to North Carolina’s Medicaid program.  Radeas had allegedly billed Medicaid for simultaneously-performed presumptive and definitive urine drug tests, in violation of Medicaid policy and standard practice to run definitive tests after presumptive tests come back positive.  NC AG

September 30, 2022

The owners and operators of three home health care companies in Illinois, Patricia and Felix Omorogbe, have been sentenced to a combined 3.5 years in prison and ordered to pay a combined $8 million in restitution for paying illegal kickbacks to patient marketers in exchange for referrals of Medicare beneficiaries.  According to the DOJ, in addition to the kickbacks, Patricia Omorogbe, a registered nurse, also falsely certified that she performed assessments on patients, causing false claims to be submitted to Medicare.  DOJ

September 27, 2022

Following a whistleblower complaint that alleged Massachusetts-based Public Consulting Group LLC (PCG) overbilled Medicaid, in violation of the False Claims Act, the company has agreed to pay $2.5 million.  According to whistleblower Shane Shackford, PCG caused local school districts to submit false claims to Medicaid while under contract with the State of New Jersey to administer its Special Education Medicaid Initiative (SEMI) program—which provides federal funding to the state and local school districts for providing certain medical services to eligible students.  For his role in the case, Shackford will received a 21% share of the settlement.  USAO NJ

September 26, 2022

Biogen Inc. has agreed to pay $900 million to resolve allegations by former employee Michael Bawduniak that the pharmaceutical company paid illegal kickbacks to physicians in order to induce prescriptions of their multiple sclerosis drugs, causing false claims to be submitted to Medicare and Medicaid.  According to Bawduniak, over a five-year period, Biogen paid kickbacks in the form of speaker honoraria, training fees, consulting fees, and free meals.  The vast majority of the settlement proceeds (over $840 million) will go to the federal government, while the remainder will be divided among 15 states.  USAO MA

September 14, 2022

Illinois-based pharmaceutical company Akorn Operating Company LLC has agreed to pay $7.9 million to resolve allegations of violating the False Claims Act by causing Medicare to pay for three generic drugs that stopped being eligible for coverage when their original manufacturers converted the brand name drugs from prescription only to over-the-counter.  According to a whistleblower, the brand name drugs in question were converted in February 2020 and June 2021, but Akorn knowingly failed to seek conversion of their generics until a year later because it knew over-the-counter drugs were non-reimbursable.  USAO MA

September 14, 2022

New York-Presbyterian/Queens Hospital has agreed to pay over $2.5 million to settle allegations that a former physician repeatedly performed and billed federal healthcare programs for medically unnecessary procedures, at the risk of patient health.  The procedures involved replacing batteries in an implanted pacemaker type device, even though batteries were still functioning normally and did not yet need to be replaced.  USAO EDNY

September 9, 2022

Daniel Pintado Cazola, the true owner of durable medical equipment company Myers Professional Services, has been sentenced to over 7 years in prison for defrauding Medicare and Medicaid and going to great extents to conceal his connection to the crimes.  Pintado Cazola admitted that he purchased lists of Medicare beneficiaries and directed employees to submit over $2.3 million in fraudulent claims to Medicare and Medicaid for durable medical equipment that was not medically necessary, not prescribed by a doctor, and not supplied to a beneficiary.  USAO SDFL

September 2, 2022

Bayer Corporation, together with its subsidiaries, will pay $40 million to settle claims initiated by a whistleblower alleging that the pharmaceutical manufacturer violated the False Claims Act by engaging in off-label marketing, unlawful kickbacks, and misreporting of safety risks with respect to its drugs Trasylol, Avelox, and Baycol.  The whistleblower, former Bayer marketing employee Laurie Simpson, will receive approximately $11 million from the settlement.  DOJ; USAO MN; USAO NJ

September 1, 2022

Philips RS North America LLC, formerly known as Respironics, will pay over $24 million to settle claims that it provided unlawful inducements to DME suppliers in the form of physician prescribing data that the DME suppliers could use in their marketing efforts.  The case was initiated by a qui tam complaint filed by former Respironics employee Jeremy Orling, who will receive a whistleblower award of approximately $4.3 millionDOJ; USAO SC
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