Archive

October 2, 2023

Genomic Health, Inc. (GHI), a wholly-owned subsidiary of Exact Sciences Corporation that provides clinical diagnostic tests, has agreed to pay $32.5 million to resolve two separate qui tam suits alleging violations of the False Claims Act and Anti-Kickback Statute in connection with lab tests for cancer patients. GHI allegedly evaded Medicare’s 14-Day Rule—which prohibits labs from separately billing for the same covered tests within 14 days of a patient’s discharge from a hospital—by canceling and reordering tests so they fell within appropriate time frames, seeking reimbursement directly from Medicare, and writing off unpaid lab fees owed by hospitals. As a result of this settlement, the whistleblowers in the case will receive over $5.5 million. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare, Whistleblower Case, Whistleblower Rewards,

September 30, 2023

The Cigna Group has agreed to pay over $172 million and enter into a five-year Corporate Integrity Agreement in order to resolve allegations of violating the False Claims Act. According to qui tam suit by a former part-owner of a Cigna vendor, Robert Cutler—who will receive an $8.1 million share of the settlement—the healthcare company knowingly submitted inaccurate and untruthful diagnosis codes on behalf of Medicare Advantage Plan beneficiaries in order to inflate their reimbursements from Medicare. DOJ

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

September 28, 2023

The Boeing Company has agreed to pay $8.1 million to resolve allegations of violating the False Claims Act. Under a Navy contract to manufacture a tiltrotor military aircraft, Boeing allegedly failed to comply with certain manufacturing specifications, submitted false claims, and made false statements. The claims were brought in a qui tam suit by former Boeing employees, who will receive a relator’s share of $1.5 million as a result of the settlement. DOJ

Tagged in: Defense Contract Fraud, FCA Federal, Whistleblower Case, Whistleblower Rewards,

September 15, 2023

Navmar Applied Sciences Corp. has agreed to pay $4.4 million to resolve allegations of double billing and improperly shifting costs between contracts, in violation of Federal Acquisition Regulations and the False Claims Act. While under a series of Navy contracts to manufacture, design, and test emerging intelligence technologies, the company double billed for the same costs on two separate contracts, and improperly shifted costs incurred under some contracts to other contracts. DOJ

Tagged in: Defense Contract Fraud, FCA Federal,

September 13, 2023

Texas-based Oliver Street Dermatology Management LLC, which manages dermatology practices, surgical centers, and pathology labs across the country, has agreed to pay $8.9 million to resolve self-reported violations of the Anti-Kickback Statute, Stark Law, and False Claims Act. The company revealed in 2021 that some of its former senior managers had fraudulently increased the purchase price of 11 dermatology practices acquired between 2013 and 2018 in exchange for referrals. Claims arising from those referrals were found to have been submitted to Medicare. USAO NDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Reporting to Government,

September 5, 2023

Verizon Business Network Services LLC has agreed to pay over $4 million in connection with its Managed Trusted Internet Protocol Service (MTIPS), which provides federal agencies with secure connections to the internet. The company self-disclosed that its MTIPS service failed to comply with General Services Administration (GSA) contracts because it didn’t satisfy required cybersecurity protocols. DOJ

Tagged in: Cybersecurity and Data Breaches, FCA Federal, Government Procurement Fraud,

August 31, 2023

Watermark Retirement Communities LLC, which manages 79 retirement homes across the country, has agreed to pay $4.25 million to settle claims of violating the Anti-Kickback Statute and False Claims Act. According to a lawsuit launched by David Freeman, the former director of strategic growth for a nationwide home health agency (HHA), between 2014 and 2020, Watermark solicited and received kickbacks from the HHA in exchange for referrals of Medicare beneficiaries from 8 of its retirement facilities in 5 states, including Arizona, Connecticut, Delaware, Florida, and Pennsylvania. Watermark then caused false claims to be submitted in connection with those referrals. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, Whistleblower Case, Whistleblower Rewards,

August 30, 2023

Lompoc Valley Medical Center (LVMC) has agreed to pay $5 million to resolve allegations of causing false claims to be submitted to California’s Medicaid program. Under the Patient Protection and Affordable Care Act (ACA), Medi-Cal received federal funds to expand coverage to previously uninsured adults. However, LVMC knowingly claimed and received payments from the government for services that were duplicative, not reimbursable, or not priced at fair market value. CA AG

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

August 1, 2023

A now defunct clinical laboratory in Texas, BestCare Laboratory Services LLC, and its owner, Karim Maghareh, have agreed to pay another $5.7 million on top of nearly $800,000 already paid to the government to resolve an outstanding obligation under a 2018 judgment for violating the False Claims Act. The underlying lawsuit, filed in 2008 by whistleblower Richard Drummond, alleged that BestCare billed Medicare for travel by lab technicians that did not reflect the actual mileage traveled. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare, Whistleblower Case, Whistleblower Rewards,

July 31, 2023

Martin’s Point Health Care Inc. in Maine has agreed to pay almost $22.5 million to resolve a lawsuit by a former manager in its Risk Adjustment Operations group, which alleged the health plan administrator defrauded Medicare over a three year period. The former manager, Alicia Wilbur, alleged that Martin’s Point reviewed charts for their Medicare Advantage beneficiaries to identify additional diagnosis codes, then submitted those codes in claims to Medicare in order to increase reimbursements even though they were not properly supported by patient medical records. For blowing the whistle on this misconduct, Wilbur will receive a $3.8 million award. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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