Archive

April 21, 2022

Susan H. Poon, 57, will spend 70 months in federal prison, and will pay nearly $1.4 million in restitution for a scheme spanning over 3 years, and which resulted in approximately $2.2 million in fraudulent billings. Poon submitted prescriptions both with PII obtained at health fairs held by Costco and UPS, and by soliciting information from actual patients about their dependents—dependents whom Poon never saw or treated. Poon used the stolen PII to submit fraudulent durable medical equipment prescriptions to a DME manufacturer, who then unknowingly submitted false claims for reimbursement to a health insurer. In addition to the prison sentence and the owed restitution, Poon’s chiropractic license was revoked in 2019. USAO CDCA

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud,

March 24, 2022

A New York woman who defrauded the state out of millions of dollars has been sentenced to 3 to 9 years in prison and ordered to pay more than $4 million in restitution. According to the Attorney General’s Office, Leslie Montgomery lured low-income New Yorkers to Health Living Community Center under the guise of helping them find housing, then used their information to submit false claims to a Medicaid-funded managed care organization. The claims for custom-molded back braces were medically unnecessary and not requested by or provided to the intended recipients. Montgomery then hid the illegal proceeds through multiple shell companies, including LCM Livery P/U, Inc. NY AG

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Devices and DME, Money Laundering,

January 12, 2022

A diabetic shoe company, Foot Care Store, Inc., d/b/a Dia-Foot, and its President and CEO, Robert Gaynor, have agreed to pay $5.5 million to resolve allegations of billing Medicare and Medicaid for custom diabetic shoe inserts when in fact, their inserts were made using generic foot models. The alleged misconduct occurred between 2013 and 2018 and was revealed in a whistleblower’s 2018 qui tam suit. In addition to the monetary penalty, Dia-Foot has entered into a three-year Integrity Agreement that requires the company to implement updated policies and procedures and submit to quarterly independent review of its claims to Medicare and Medicaid. USAO SDFL

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Whistleblower Case,

January 5, 2022

Two Florida men, Reinier Gonzalez Caballero and Alexeis Napoles Manresa, have each been sentenced to a little over four years in prison for laundering the ill-gotten proceeds of a $3 million healthcare fraud scheme against Medicare. Over a couple months in 2019, durable medical equipment company Universal Ortho Supplies, Inc. billed Medicare for orthosis and prosthetics that were never prescribed by physicians, nor provided to patients. The reimbursements were then turned over to the defendants, who attempted to disguise the source of the funds by setting up shell corporations and opening up fake bank accounts. Two co-conspirators have already been convicted and sentenced; another two have pleaded guilty and await sentencing. USAO SDFL

Tagged in: Criminal Proceedings, Healthcare Fraud, Medical Devices and DME, Medicare, Money Laundering,

December 8, 2021

The owner and medical director of Georgia’s Milton Hall Surgical Associates, Jeffrey M. Gallups, will pay $3 million, and medical device manufacturer Entellus Medical will pay $1.2 million, to resolve claims that they entered into an unlawful kickback arrangement. The government alleged that Gallups received cash payments and all-expense paid trips from Entellus in return for directing MHSA physicians to utilize sinuplasty related medical devices exclusively from Entellus and increase the number of sinuplasty procedures performed. In addition, Gallups was alleged to have received “commissions” from medical testing laboratory NextHealth, in exchange for directing MHSA doctors to order medically unnecessary toxicology and genetic tests from NextHealth. The settlement resolves a qui tam action initiated by former MHSA physician Myron Jones, M.D., who will receive approximately $614,000 from the settlement. USAO ND GA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

November 8, 2021

Florida-based medical device company Arthrex Inc. has agreed to pay $16 million and enter into a five-year corporate integrity agreement to resolve allegations of paying kickbacks to a Colorado-based orthopedic surgeon in exchange for the surgeon’s use and recommendation of its products. According to a qui tam suit by whistleblower Joseph Shea, the kickbacks were disguised as royalty payments for the surgeon’s contributions to Arthrex’s SutureBridge and SpeedBridge products. For his role in the case, Shea will receive a relator’s share of $2.5 million. USAO MA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

November 5, 2021

Two men who pleaded guilty to causing $134 million in false claims to be submitted to Medicare and CHAMPVA have been sentenced to federal prison and ordered to pay restitution of over $29 million. Michael Nolan of Florida was sentenced to 6.5 years, while Richard Epstein of Colorado was sentenced to about 5 years. Using a telemarketing company called REMN Management LLC, as well as a telemedicine company called Comprehensive Telcare LLC, Nolan and Epstein had bribed physicians to sign medically unnecessary orders for durable medical equipment, which they then sold to co-conspirators as support for the false claims. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Other Government Health Programs,

August 26, 2021

SuperCare Health, Inc., which provides home respiratory services and DME, will pay $3.3 million to resolve claims that the company submitted false claims for non-invasive ventilators in cases where those patients were no longer using the NIVs. The case was initiated by the filing a whistleblower complaint by a former SuperCare respiratory therapist, Benjamin Martinez. Mr. Martinez will receive a $612,000 whistleblower reward from the federal government. USAO CD Cal

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

August 2, 2021

Diabetic testing supply company Arriva Medical LLC and its parent company Alere Inc. will pay $160 million to resolve claims first brought in a whistleblower case alleging that Arriva provided unlawful patient inducements in the form of “free” or “no cost” glucometers and copayment waivers. Defendants were alleged to have systematically provided all new patients with glucometers, and billed Medicare for those meters, although Medicare beneficiaries are only eligible for a new meter once every five years. In addition, Arriva was alleged to have billed Medicare for deceased beneficiaries. The whistleblower, Gregory Goodman, who was an employee at an Arriva call center, will receive a whistleblower award of $28.5 million. Executives at Arriva previously agreed to a settlement of claims against them. DOJ; USAO MD Tenn

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

July 8, 2021

Medical supply company Avanos Medical Inc. entered into a deferred prosecution agreement and will pay $22.2 million to resolve charges that it sold misbranded surgical gowns, labeling the MicroCool gowns as providing the highest level of fluid and virus protection under ANSI/AAMI standards, when the company knew the gowns had never met that standard. The government also alleged that Avanos obstructed FDA inspection efforts. ND Tex

Tagged in: Criminal Proceedings, FDA Fraud, Medical Devices and DME,

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