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July 16, 2021

Florida Neurological Center, LLC and its owner Dr. Lance Kim have agreed to settle a whistleblower-brought suit and pay $800,000 to resolve allegations of defrauding Medicare.  The qui tam suit by Michael Singbush, Andrea Herrera, and Harvey Kessler Meyer, IV alleged that Dr. Kim prescribed medically unnecessary prescription drugs, which cost Medicare $35,000 each time it was prescribed.  For their role in the successful enforcement action, the whistleblowers will share in a $144,000 award.  USAO MDFL

July 9, 2021

Genetworx Laboratories, a diagnostic laboratory in Virginia, has agreed to pay $1.4 million to resolve allegations of submitting false claims to Medicare in violation of the False Claims Act.  Over the course of a year, Genetworx allegedly billed for genetic tests that were performed on groups of senior citizens in senior homes without valid physician oversight.  USAO NJ

June 28, 2021

Surgical Care Affiliates, LLC and Orlando Center for Outpatient Surgery, LP have agreed to pay $3.4 million to resolve a whistleblower’s allegations that they billed Medicare and TRICARE for medically unnecessary kidney stone procedures.  The centers also engaged in an illegal kickback arrangement whereby urologist Dr. Patrick Hunter performed lithotripsy procedures in exchange for per-procedure payments from the Orlando Center.  For bringing a successful action, whistleblower Scott Thompson will receive a relator’s share of $748,000 from the settlement with SCA and the Orlando Center.  USAO MDFL

July 2, 2021

Select Medical Corporation (SMC) and Encore GC Acquisition LLL have agreed to pay $8.4 million to settle allegations that contract rehabilitation therapy provider Select Medical Rehabilitation Services Inc. (SMRS)—a previous subsidiary of SMC and current subsidiary of Encore—violated the False Claims Act.  According to former SMRS employee Melissa Vail, SMRS’s desire to maximize profits led it to provide medically unnecessary, unreasonable, and unskilled therapy services, and subsequently caused twelve skilled nursing facilities in the New York and New Jersey area to submit false claims to Medicare over a six-year period.  USAO NJ

June 25, 2021

Connecticut Addiction Medicine, LLC (CAM) and its owners, Dr. Jay Benson and Dr. Mahboob Aslam, have agreed to pay over $1 million to resolve their liability under the False Claims Act in connection with overcharges for urine drug tests that they caused to Medicare and Medicaid.  As part of their standard practice, CAM ran presumptive tests in-house but also sent the same sample out to an independent reference laboratory for definitive tests.  CAM then billed federal healthcare programs for the medically unnecessary presumptive tests.  USAO CT

June 23, 2021

El Paso Ear, Nose & Throat Associates (EPENT) has agreed to pay $750,000 to settle allegations of defrauding Medicaid, Medicare, and TRICARE.  In violation of the False Claims Act, EPENT allegedly billed the programs at a higher rate of reimbursement than what they were actually entitled to by upcoding evaluation and management codes.  USAO WDTX

June 11, 2021

Two integrative chiropractic practices in Pennsylvania and their chiropractor owners have agreed to pay over $800,000 to resolve liability under the False Claims Act in connection with an electro-acupuncture device.  The settling parties are Discover Optimal Healthcare, affiliate Weigner Healthcare Management Group, LLC, and owner Jason Weigner (collectively, “Weigner”), and Yucha Medical Pain Management & Chiropractic Rehabilitation, LLC, and owners Randolph Yucha and Rodney Gabel.  Between 2016 and 2017, the parties allegedly billed Medicare and the Federal Employees Health Benefit Program for the surgical implantation of neuro-stimulators, even though the devices involved—ANSiStim—are not reimbursable and can be applied with adhesives.  USAO EDPA

June 10, 2021

Three Texas-based healthcare providers who allegedly billed Medicare for non-reimbursable procedures involving electro-acupuncture devices have agreed to pay over $1 million in settle their liability under the False Claims Act.  For up to two years, each of the providers—Ledger Foot & Ankle, P.A., SPR Medical Group d/b/a Superior Physical Medicine, and Precision Spine and Pain Management—allegedly billed the application of two pain management devices, ANSiStim and STIVAX, as though they were implantable neurostimulators, when in fact their application was non-surgical and non-invasive.  Following a Medicare audit, Superior and Precision self-disclosed improperly billed claims and initiated refund payments to Medicare.  USAO WDTX

June 8, 2021

The chiropractor owner and operator of Texas-based Campbell Medical Group PLLC and Johnson Medical Group PLLC d/b/a Campbell Medical Clinic has agreed to pay $2.6 million to settle claims that she and the entities defrauded Medicare and TRICARE.  As part of the settlement, Suhyun An and her medical entities will be excluded from participating in federal healthcare programs for ten years.  Ms. An and the medical entities allegedly improperly obtained over $3.9 million in reimbursement for unbillable implantations of neurostimulator electrodes.  USAO SDTX

May 28, 2021

Erik Santos of Georgia was sentenced to more than 11 years in prison following his guilty plea on healthcare fraud charges.  Santos conspired with Florida compounding pharmacy Patient Care America and others to recruit Tricare beneficiaries to fill prescriptions for expensive, supposedly tailor-made, compounded medications that consisted of little more than common pain or scar creams, but came with price tags as high as $10,000-$15,000 per month.  The beneficiaries did not need the medications, which had little to no therapeutic value, and Santos secured the prescriptions by paying doctors, who had not actually seen the beneficiaries, to approve pre-printed prescriptions for large amounts of these medications.  Santos’s fraudulent referrals caused an actual loss to the Tricare program of approximately $12 million.  PCA pharmacy paid Santos over $7 million in prescription referral kickbacks.  In addition to the prison sentence, the Court imposed restitution in the amount of $11.8 million and entered a forfeiture judgement of approximately $7.6 million.  USAO SD FL
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