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April 8, 2021

South Carolina’s largest urgent care provider, Doctors Care, P.A., and its management company, UCI Medical Affiliates of South Carolina, Inc. (UCI), have agreed to pay $22.5 million and enter into a Corporate Integrity Agreement to resolve a whistleblower suit alleging violations of the False Claims Act.  From 2013 to 2018, UCI allegedly submitted false claims to Medicaid, Medicare, and TRICARE by linking services rendered by Doctors Care providers who lacked proper billing credentials—which are separate from a degree or license to practice medicine—to providers who did hold the proper credentials.  Under the Corporate Integrity Agreement, UCI will retain an independent claims reviewer for the next five years.  USAO SC

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

April 6, 2021

Health Net Federal Services LLC paid over $97 million to resolve claims that it overcharged the Department of Veterans Affairs as the third-party administrator under the Patient-Centered Community Care Program.  Health Net's alleged overbilling, which included billing the VA for duplicate claims and failing to pass on provider rate savings to the VA, was discovered in an audit by the VA Office of the Inspector General.  USAO EDCA

Tagged in: Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs,

April 1, 2021

Pharma company Bristol-Myers Squibb will pay $75 million to settle a False Claims Act action, filed by a whistleblower, alleging that the company failed to pay amounts it owed under the Medicaid Drug Rebate Program. That program, the MDRP, requires drug manufacturers to report the Average Manufacturer Prices (AMPs) of their Medicaid-covered drugs to the government; the higher the reported AMPs, the greater the rebate owed by the pharma company to the government.  The whistleblower alleged that Bristol-Myers systematically under-reported their AMPs for a number of its drugs, including by reducing service fees it paid to wholesalers and excluding the value of price appreciation provisions in wholesale contracts. Of the total settlement, $41 million will be paid to the federal government, and the remainder to states participating in the settlement.  The government did not intervene, and the action was pursued by the whistleblower, Ronald J. Streck, who will receive an undisclosed share of the settlement.  USAO EDPA

Tagged in: Drug and DME Pricing, FCA Federal, Healthcare Fraud, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

March 26, 2021

Following two whistleblower complaints, a former owner of a now-defunct diagnostic testing laboratory in North Carolina and South Carolina has agreed to pay $2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  Together with other agents of Physicians Choice Laboratory Services (PCLS), Phillip McHugh allegedly offered and provided benefits to physicians in exchange for referrals of patient samples, causing false claims to be submitted to Medicare.  A second defendant in the case, former sales representative and manager Manoj Kumar, has already paid approximately $650,000 to resolve similar claims.  USAO WDNC

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

March 24, 2021

Two men in Mississippi have been sentenced to 7 years in prison and ordered to pay over $16 million in restitution to Medicare, TRICARE, and Express Scripts, as well as forfeiture of close to $1 million, for their roles in a multimillion-dollar healthcare fraud scheme.  Dempsey Bryan Levi and Jeffrey Wayne Rollins, the operators of the Gardens Pharmacy, LLC, had previously admitted to soliciting and incentivizing recruiters to obtain prescriptions for highly reimbursed compounded medications, and soliciting and incentivizing doctors to authorize those prescriptions.  USAO SDMS

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Pharma Fraud,

March 23, 2021

Medical device manufacturer Boston Scientific Corporation has agreed to pay $188.6 million to 47 states and the District of Columbia to resolve allegations concerning its transvaginal surgical mesh, which were found to be deceptively marketed in violation of consumer protection laws and allegedly caused serious complications for thousands of women nationwide.  As part of the settlement, Boston Scientific also agreed to implement various marketing, training, and clinical trial reforms.  Similar settlements were previously reached with other medical device manufacturers, including Johnson & Johnson, which paid $116.9 million in 2019, and C.R. Bard, which paid $60 million in 2020.  CA AG; FL AG; NY AG

Tagged in: Defective Products, Medical Devices and DME,

March 23, 2021

The former owner of Shape of Behavior (TSOB), a Texas-based therapy service provider for children with autism, has agreed to pay $2.7 million to resolve allegations that nine of the provider’s locations submitted improper claims to TRICARE.  The misconduct was uncovered by TRICARE’s managed care support contractor, Humana Military Program Integrity, and involved claims that could not be substantiated by medical records, claims involving excessive hours by individual providers, and misrepresentations of the identities of actual rendering providers.  USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud,

March 18, 2021

A Michigan-based cardiologist, Dinesh Shah, and his practice, Michigan Physicians Group, P.C. (MPG), have agreed to pay $2 million to resolve allegations of defrauding Medicare, Medicaid, and TRICARE by submitting claims for medically unnecessary diagnostic testing, in violation of the False Claims Act.  In separate qui tam suits filed by former employees Arlene Klinke and Khrystyna Mala, the whistleblowers alleged that between 2006 and 2017, Shah and MPG billed government healthcare programs for Ankle Brachial Index tests, Toe Brachial Index tests, and Nuclear Stress Tests that were ordered and provided without regard to necessity.  USAO EDMI

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

March 16, 2021

Jack Lee Stapleton and Jack Hunter Stapleton, the former owners of a Florida-based telemarketing company known as CV McDowell LLC or J&J Tel Marketing LLC (the Stapleton Entities), have agreed to pay at least $4 million to resolve a qui tam case by a former employee alleging violations of the False Claims Act.  According to whistleblower Dwayne Thornton, the Stapletons solicited prospective patients through telemarketing calls, convinced them to accept compounded drugs regardless of need, and then procured prescriptions and sent them to compounding pharmacies that agreed to pay the Stapletons half of all TRICARE reimbursements.  USAO MDFL

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs, Whistleblower Case,

March 8, 2021

Vascular surgeon Feng Qin and his medical practice Qin Medical P.C. will pay $800,000 to resolve civil claims and criminal charges that Qin performed procedures on end-stage renal disease patients that were not medically reasonable and necessary, and fraudulently billed Medicare.  Qin performed vascular access procedures on patients on a routine scheduled basis, without documenting the required clinical findings.  The government’s investigation was initiated by the filing of a qui tam complaint by Mark Favors.   USAO SDNY

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

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