Archive

July 20, 2022

Texas-based clinical laboratory Inform Diagnostics, Inc., formerly known as Miraca Life Sciences, Inc., has agreed to pay $16 million to resolve allegations of violating the False Claims Act. Inform admitted that it had a policy of conducting additional tests on biopsy specimens without an individualized determination on whether additional tests were medically necessary, then submitting bills for those unauthorized and unnecessary tests to Medicare and other federal healthcare programs. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Other Government Health Programs,

July 14, 2022

BioReference Health, LLC, formerly known as BioReference Laboratories, Inc. and OPKO Health, Inc., have agreed to pay nearly $10 million and enter into a five-year Corporate Integrity Agreement to settle a whistleblower-brought case alleging it violated the Anti-Kickback Statute, Stark Law, and False Claims Act. The alleged misconduct involved making lease payments to healthcare providers that exceeded fair market value, and later failing to report or return any overpayments to federal healthcare programs. USAO MA

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

June 28, 2022

Fifteen additional doctors affiliated with a kickback scheme involving Rockdale Hospital d/b/a Little River Healthcare, True Health Diagnostics LLC, and/or Boston Heart Diagnostics Corporation, have agreed to pay a cumulative $2.8 million to settle allegations of violating the Anti-Kickback Statute and Stark Law by accepting improper remuneration in exchange for ordering tests from those laboratories. According to the press release, the government has now recovered over $32 million from settlements with thirty-three doctors, two executives, and one laboratory in connection with this scheme. USAO EDTX

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

June 16, 2022

A Florida man who was convicted of defrauding Medicare of over $20 million and evading taxes has been sentenced to 14 years in prison and ordered to pay $4 million in restitution to the IRS. As the owner and operator of multiple telemarking and telemedicine companies, Marc Sporn marketed and sold signed prescription orders for medically unnecessary genetic tests, in exchange for illegal kickbacks from pharmacies and laboratories. USAO SDFL

Tagged in: Criminal Proceedings, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Tax Fraud,

June 6, 2022

SNAP Diagnostics LLC, along with its founder, Gil Raviv, and vice president, Stephen Burton, will pay a combined $3.925 million to settle allegations of False Claims Act and Anti-Kickback Statute violations. SNAP routinely submitted claims for Medicare and TRICARE patients’ second and third nights of home sleep testing, when patients with private health insurance were routinely billed only for the first night. Additionally, SNAP multiplied copays from senior citizen Medicare beneficiaries, and incentivized physicians to refer their patients for sleep testing services. USAO NDIL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

June 3, 2022

Rodney L. Yentzer will pay $900,000 for violating the False Claims Act. Through Pain Medicine of York, a group of clinics he controlled, Yentzer caused the submission of false claims for payment to Medicare for urine drug tests that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. He is excluded from participation in all federal health care programs for 22 years. In March of 2022, Yentzer pleaded guilty to Health Care Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the U.S. Department of Health and Human Services between 2016 and 2020. USAO MDPA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud,

June 1, 2022

Caris Life Sciences, Inc. will pay $2.9 million to resolve claims that it falsely billed Medicare for laboratory tests to detect the activity of certain genes within a tumor that predicted the risk of recurrence by fraudulently circumventing Medicare’s 14-day rule, which, during the relevant time period, prohibited laboratories from separately billing Medicare for tests performed on specimens if a physician ordered the test within 14 days of the patient’s discharge from a hospital stay. By submitting separate claims for the laboratory tests, Medicare paid twice for the same service, first to the hospital as part of the hospital’s lump-sum DRG payment, and in a direct payment to Caris. Caris allegedly discouraged providers from ordering testing within 14 days of discharge, or canceled and re-submitted orders to avoid the 14 day window. The settlement covers two separate whistleblower actions. USAO EDNY

Tagged in: Anonymity, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case,

May 19, 2022

Healthcare testing company VirtuOx, Inc. agreed to pay $3.15 million to resolve claims brought in an action initiated by a whistleblower alleging that falsely billed Medicare for pulse oximetry testing. VirtuOx allegedly reported San Francisco as the location for overnight pulse oximetry testing when, in fact, no services were performed at that location, but that location resulted in a higher Medicare reimbursement. In addition, VirtuOx allegedly billed Medicare for both oxygen “spot checks” and overnight pulse oximetry testing, when only the overnight testing was performed. The whistleblower, Amber Watt, will receive an award of $630,000. USAO SD FL

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

March 31, 2022

Clinical laboratory Radeas LLC has agreed to pay $11.6 million to resolve claims that it submitted false claims to Medicare for medically-unnecessary urine drug tests. As part of the settlement agreement, Radeas admitted that it regularly performed and billed Medicare for essentially simultaneous presumptive qualitative drug testing and confirmatory quantitative drug testing. Without physician review of a presumptive test result, the separate, simultaneous confirmatory test was often not necessary. Radeas also admitted that it paid third-party sales organizations based on the volume of UDT referrals in violation of the Anti-Kickback Statute. USAO MA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

March 22, 2022

Ten doctors in Texas and a healthcare executive have agreed to pay nearly $1.7 million to resolve allegations of violating the False Claims Act, Anti-Kickback Statute, and Stark Law. In exchange for ordering laboratory tests from Rockdale Hospital d/b/a A little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation, the doctors allegedly received thousands of dollars in kickbacks disguised as investment returns. USAO EDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

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