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April 4, 2023

From 2014 to 2022, medical testing company Genotox Laboratories Ltd. paid kickbacks to their “1099” representatives, calculated as a percentage of the revenue Genotox received from Medicare, the Railroad Retirement Board, and TRICARE billings for testing orders facilitated or arranged for by these representatives. In addition to the kickbacks, Genotox also allowed providers to create “custom profiles” to pre-select the tests to order for their patients, often resulting in medically unnecessary testing, such as definitive drug testing for 22 or more drug classes. Genotox will pay $5.9 million, and Genotox’s former billing manager—the whistleblower in this qui tam action—will receive approximately $1 million. DOJ

March 27, 2023

Laboratory Corporation of America (“Labcorp”) has agreed to pay $2.1 million to settle a lawsuit by former employee Donna Hecker-Gross, who alleged that Labcorp overbilled the Department of Defense for genetic tests performed by a third party.  Under a 2012 contract, Labcorp was to perform laboratory testing for military treatment facilities worldwide, but certain specialized tests would be performed by subcontractor GeneDx.  However, when billing the Department of Defense for tests performed by GeneDx, LabCorp allegedly overcharged for them, double or triple billed for them, or billed for them even in the absence of evidence the tests were ever performed.  For initiating a successful enforcement action, Hecker-Gross will receive a $357,000 relator’s share.  USAO MD

March 20, 2023

Acute care hospital Luminis Health Doctors Community Medical Center, Inc. (“DCMC”) and radiology imaging practice Diagnostic Imaging Associates, LLC (“DIA”) have agreed to pay $2 million to resolve allegations of defrauding federal healthcare programs.  Because DCMC’s outpatient cancer screening facility was not enrolled in Medicare and Medicaid and was thus not eligible for reimbursements, it entered into a written agreement with DIA whereby DIA would bill the programs for services performed by DIA as well as DCMC’s outpatient cancer screening facility, in violation of program rules and the False Claims Act.  The alleged misconduct occurred between 2010 and 2020.  USAO MD

February 7, 2023

A startup that operates as an online pharmacy for birth control and contraceptives has agreed to pay $15 million to settle whistleblower claims of defrauding California’s Medicaid program of millions of dollars.  In violation of the state False Claims Act, The Pill Club allegedly billed for ineligible services, services not rendered, and enormous quantities of expensive products not ordered by customers.  Investigators found that even in cases where customers asked to stop receiving those products, the company continued to dispense enormous quantities and bill the government for them.  CA AG

February 7, 2023

United Energy Workers Healthcare, Corp., which provides home health services in multiple states, has paid $9 million to resolve allegations of submitting false claims to the U.S. Department of Labor on behalf of beneficiaries of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).  Multiple whistleblowers alleged that between 2013 and 2021, the defendant and related entities billed for services that were either not covered under EEOICPA program rules, not medically necessary, not provided by appropriately licensed individuals, or not provided entirely.  USAO SDOH

January 30, 2023

A doctor in Michigan who was involved in a $250 million fraud scheme against Medicare, Medicaid, and other insurers, has been sentenced to 16.5 years in prison.  Along with 21 co-conspirators, Dr. Francisco Patino took advantage of patients suffering from addiction by forcing them to receive medically unnecessary, painful, but lucrative spinal injections in exchange for opioid prescriptions.  Additionally, Patino knowingly violated the Anti-Kickback and Stark laws by receiving kickbacks from a laboratory in exchange for sending patient samples to that lab.  All told, Patino submitted more claims to Medicare for spinal injections than any other provider in the country between 2012 and 2017, prescribed more Oxycodone than any other provider in Michigan in 2016 and 2017, and was personally responsible for $120 million of the $250 million in false claims billed to insurers.  DOJ

January 9, 2023

Doctor Aarti Pandya and her practice, Aarti D. Pandya, M.D. P.C., have agreed to pay $1.8 million to resolve a whistleblower suit that alleged they billed federal healthcare programs for medically unnecessary cataract surgeries and diagnostic tests, incomplete or worthless tests, and office visits that failed to provide the level of service claimed.  The allegations were brought in a 2013 qui tam suit by former employee Laura Dildine, which the government intervened on in 2018. In addition to the false claims listed above, Pandya also allegedly falsely diagnosed patients with glaucoma in order to justify claims for reimbursement.  USAO SDGA

December 22, 2022

New York doctor David DiMarco and his companies, D. B. DiMarco, M.D., P.C. and DiMarco Vein Centers LLC, has agreed to pay $2 million to New York’s Medicaid program and withdraw from providing services to it after an investigation found DiMarco submitted false claims between 2015 and 2021.  According to the NY AG’s office, DiMarco submitted more than a thousand claims for procedures without sufficient documentation showing the procedures performed or their medical necessity.  AG NY

December 20, 2022

BioTelemetry Inc. and its subsidiary CardioNet LLC, which provide cardiac monitoring services (including Holter and mobile cardiovascular telemetry (MCT) tests), will pay $44.875 million to resolve claims that they submitted false claims to federal healthcare programs for cardiac monitoring services that were improperly performed overseas and by unqualified technicians.  CardioNet used an India-based contractor to perform diagnostic and analysis services of heart monitoring data, and while it had a formal policy of sending such data for federal healthcare beneficiaries to a U.S.-based independent diagnostic testing facility for review and analysis, in fact, substantial amounts of such data was sent to its Indian contractor.  The government further alleged that most of the offshore technicians tasked with reviewing ECG Data for federal healthcare program beneficiaries did not have the basic qualifications to perform the tests in question. The government’s investigation was initiated by a qui tam action filed by former CardioNet employees Christopher Strasinski and Philip Leone, who will share a whistleblower award of approximately $8.3 millionDOJ; USAO ED PA

December 15, 2022

A physician and his Connecticut-based urgent care practices have agreed to pay over $4.2 million to settle allegations of submitting false claims to Medicare and the Connecticut Medicaid program.  Jasdeep Sidana—the owner and CEO of Docs Medical Group, Inc., Docs Medical Inc., Docs Urgent Care LLP, Lung Docs of CT, P.C., Epic Family Physicians, LLP, and Continuum Medical Group, LLC (collectively, DOCS)—allegedly billed for immunotherapy services, including allergy testing and treatment, that were not medically necessary and not directly supervised by a physician.  Additionally, the defendants allegedly billed for COVID test administration using codes for more complex evaluation and management (“E&M”) services.  USAO CT
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