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August 27, 2021

John Peter Smith Hospital (JPS) in Texas has agreed to pay more than $3.3 million to resolve a qui tam suit filed by its former Director of Compliance, Erma Lee, which alleged that the hospital routinely applied billing modifiers that essentially double-billed federal healthcare programs for certain aspects of patients’ care.  Even after raising the issue internally, JPS allegedly failed to reimburse payors, prompting Lee to file the case in 2018.  For doing so, Lee will receive over $900,000 of the settlement proceeds.  USAO NDTX

August 26, 2021

The owner of jet charter company All in Jets dba JetReady, Seth Bernstein, has agreed to pay $287,055 to resolve allegations that he misappropriated company Paycheck Protection Program loan proceeds for his personal use.  Whistleblower Victoria Hablitzel, a former JetReady employee, reported defendant’s conduct by filing a qui tam action, and will receive a relator’s share of $57,411DOJ; USAO SD FL

August 26, 2021

Mental health and addiction services provider Connections Community Support Programs, Inc. has consented to the entry of judgment ordering payment of $15.3 million to resolve claims that it billed federal healthcare programs for mental health services performed by individuals without required professional qualification, billed using incorrect procedure codes, and failed to keep proper records regarding controlled substances.  Connections has filed for bankruptcy, and the government recovery will be limited by the availability of funds in the bankruptcy estate.  The settlement resolves claims brought in a qui tam lawsuit by two former Connections employees.  USAO Del

August 25, 2021

A California-based provider of home respiratory services and durable medical equipment has agreed to pay $3.3 million to the United States and States of California and Nevada to settle allegations of defrauding Medicare and Medicaid.  The claims against SuperCare Health, Inc. were brought in a 2018 qui tam suit by respiratory therapist Benjamin Martinez, who alleged that the provider billed for non-invasive ventilators (NIVs) that were no longer needed or being used by patients.  CA AG; USAO CDCA

August 19, 2021

Nevada Advanced Pain Specialists agreed to pay $1 million to resolve allegations that it submitted false claims for confirmatory urine drug testing performed without regard to the results of presumptive tests that had been performed. The allegations were first brought in a qui tam lawsuit filed by an whistleblower Omni Healthcare, Inc., which will receive a relator’s share of $150,000 of the settlement.  USAO MA

August 17, 2021

Following a voluntary self-disclosure to authorities, Blessing Hospital in Quincy, Illinois, has agreed to pay $2.82 million to resolve allegations that it submitted false claims for the facility component of medically unnecessary cardiac catheterization procedures.  The federal government will receive $2.6 million of the settlement, with the remainder going to Illinois, Iowa, and Missouri.  USAO CD IL

August 9, 2021

Ralph Hackett, a fruit broker in California’s Central Valley, will pay $1.255 million to resolve criminal charges and civil claims arising from his role in a crop insurance fraud scheme.  In a guilty plea, Hackett acknowledged that he authorized alterations to business records and misstatements to underreport the table grapes sold by another individual, so that the individual could submit fraudulent crop insurance claims between 2012 and 2015.  Hackett agreed to pay criminal restitution of $650,000 and a civil penalty of $605,000; his prison sentence is yet to be determined.  USAO ED Cal

August 9, 2021

The owners of North Carolina compounding pharmacy Wellcare Compouding, David Tsui and Lois Tsui, paid $1.1 million to resolve allegations that they violated the False Claims Act by submitting false claims for payment to the TRICARE program in 2014 and 2015.  The government alleged that Wellcare made improper payments to physicians and “marketers” in violation of the Anti-Kickback Statute and encouraged medically unnecessary prescriptions consisting of high-margin ingredients in order to maximize the pharmacy’s reimbursement. David Tsui had been convicted of healthcare fraud in 2009 and was excluded from participation in federal healthcare programs; the government alleged that his involvement and ownership was intentionally concealed.  USAO MD NC

August 6, 2021

A county in California and a county medical center have agreed to pay $11.4 million to resolve allegations of improperly billing a federal healthcare program between 2013 and 2017.  According to whistleblower Felix Levy, a former employee of San Mateo County Medical Center (SMMC), San Mateo County and SMMC billed Medicare for uncovered hospital stays for patients that were admitted without regard to medical necessity.  USAO NDCA

August 5, 2021

Tennessee’s Department of Human Services has agreed to pay nearly $7 million to resolve allegations of submitting false information to the USDA’s Supplemental Nutrition Assistance Program, known until 2008 as the Food Stamp Program.  Under the direction of the Julie Osnes Consulting firm, numerous state agencies—including Alaska, Florida, Louisiana, Mississippi, Texas, Virginia, and Wisconsin—allegedly submitted false quality control data to the USDA, receiving performance bonuses as a result.  This is the ninth settlement in the matter; more than $67 million has been recovered thus far.  USAO EDWA
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