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December 6, 2021

Pharmacy benefit manager Centene Corp. will pay $27.6 million to the State of Kansas to resolve allegations that it failed to satisfy its obligation to represent the state’s best interests in negotiations with companies that supply drugs to the state Medicaid program, failed to accurately report discounts it received from CVS-Caremark on certain retail pharmacy claims, and artificially inflated dispensing-fee amounts reported to state regulators.  The state alleged that Centene used an opaque reporting system that made it difficult for the state to determine the nature and appropriateness of certain pharmacy transactions.  As part of the settlement, Centene also agreed to change certain business practices to ensure greater transparency.  KS

November 29, 2021

General contractor J.A. McDonald, Inc. has agreed to pay $637,500 to settle allegations of presenting false claims to the United States and State of Vermont in connection with the federally-funded construction of several bridges.  Employees at the company allegedly made material alterations, then took steps to conceal those alterations from the Vermont Agency of Transportation, which then caused the agency to submit false claims to the Federal Highway Administration.  USAO VT

November 22, 2021

Seven financial institutions – Barclays Capital Inc., Citigroup Global Markets Inc., Goldman Sachs & Co. LLC, J.P. Morgan Securities LLC, Merrill Lynch, Pierce, Fenner & Smith Incorporated, NatWest Markets Securities Inc., and Washington Mutual Mortgage Securities Corp. – have agreed to collectively pay $32.5 million to resolve claims by New Mexico that the banks did not adequately disclose the characteristics of certain mortgage-backed securities sold to New Mexico pension funds and a state-run investment council between 2003 and 2010.  The settlement resolves a qui tam action under the New Mexico Fraud Against Taxpayers Act brought by Integra REC, LLCNM

October 22, 2021

Texas doctors Robert Wills and Brannon Frank, who previously operated Austin Pain Associates, will pay $3.9 million to resolve allegations that they billed federal and state healthcare programs for medically unnecessary urine drug tests that were performed at Austin Pain Associates’ in-house lab.  The investigation was initiated after a whistleblower complaint was filed by former Austin Pain Associates employees Jennifer Nuessner and Robert Hoffman; they will receive approximately $618,000 from the federal share of the settlements. DOJ

October 14, 2021

Owners and executives of Massachusetts mental health provider South Bay Mental Health Center, Inc. have agreed to pay $25 million to resolve claims that they caused the submission of false claims to the state’s Medicaid program, MassHealth, by billing for services provided by unlicensed, unqualified, and improperly supervised staff members in violation of MassHealth regulations. Defendants  H.I.G. Growth Partners, LLC and H.I.G. Capital, LLC will pay $19.95 million and defendants Peter J. Scanlon and Kevin P. Sheehan, who held executive and board positions at relevant entities, will pay $5.05 million.  The case was initiated by the filing of a whistleblower complaint under the Massachusetts False Claims Act.  SBMHC previously agreed to pay $4 million to resolve related charges.  Mass

September 27, 2021

The State of New York has reached a $6 million settlement with electricity provider National Grid to resolve a fraud investigation launched by a whistleblower’s qui tam suit.  As part of its contract with the Long Island Power Authority (LIPA), National Grid was tasked with reading meters, collecting payments, and providing customer service, while LIPA provided the actual electricity.  For over four years, however, National Grid allegedly underreported the amount of electricity being delivered to homes and businesses, costing LIPA and the state millions in lost revenue.  The whistleblower in this matter will receive $1.41 million, while the settlement proceeds will go toward subsidizing energy upgrades for low-income residents.  NY AG

August 26, 2021

In-home care provider At Home Care LLC and its principal, Kevin Cox, will pay a total of $2.9 million to resolve allegations that they overcharged the Oregon Medicaid program, including by altering caregiver scheduling records and falsely billing for hours of in-home care that were not actually provided.  The company pleaded guilty to healthcare fraud charges, and agreed to be excluded from government healthcare programs.  USAO Or

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 17, 2021

Bristol Myers Squibb (BMS) has agreed to pay $75 million to a resolve a whistleblower’s allegations that it underpaid drug rebates owed to state Medicaid programs nationwide.  In order to ensure states pay competitive prices, federal law requires pharmaceutical companies to return a portion of payments from state Medicaid programs, calculated based on the average price paid by drug wholesalers.  The misconduct involved BMS underreporting their drugs’ Average Manufacturer’s Price by treating wholesaler fees as discounts, thus decreasing the amount it supposedly owed to the healthcare programs.  CA AG; NJ AG
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