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February 26, 2021

United Airlines will pay a total of $49 million to resolve criminal and civil claims that its cargo division fraudulently overcharged the U.S. Postal Service under International Commercial Air (ICAIR) contracts by which United transported U.S. mail internationally.  While the contracts required United to bill the government based on the delivery of mail receptacles, as supported by departure and arrival scans of the receptacles, United submitted false data that was not based on actual scans or the movement of mail, and United employees who knew about the false data and billings took steps to conceal this information.  To resolve the criminal claims, United will pay $17.3 million in penalties and enter into a non-prosecution agreement including specific compliance and reporting requirements; to resolve civil claims under the False Claims Act, United will pay $32.2 million.  DOJ

Tagged in: Contract Non-Compliance, Criminal Proceedings, Falsifying Invoices, FCA Federal, Government Procurement Fraud,

February 25, 2021

Following a self-disclosure to the U.S. Department of Health and Human Services in 2018, Bioventus, LLC has agreed to pay more than $3.6 million to resolve allegations of violating the False Claims Act in connection with sales of its Exogen ultrasonic bone growth stimulator device.  According to Bioventus, it discovered that its sales representatives sometimes improperly completed sections of certificates of medical necessity (CMN) that Medicare rules require be completed by treating physicians or physician offices.  USAO MDNC

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

February 25, 2021

Texas Center for Orthopedic and Spinal Disorders and its owner, osteopath Mark Kuper, have agreed to a judgment of $11.2 million to resolve claims arising from their fraudulent billing of government healthcare programs.  Kuper also pleaded guilty to healthcare fraud, and was sentenced to 10 years in prison.  Defendants admitted that they submitted claims for services that were never rendered, including claims for one-on-one physical therapy pursuant to an individualized plan of care, when patients were actually attending group sessions with an athletic trainer, and claims for 60-minute psychotherapy sessions when patients actually spoke with unqualified individuals for just 15-20 minutes.  In addition, Kuper permitted his wife to use his credentials to issue prescriptions for controlled substances.  The civil investigation was initiated by a qui tam complaint filed by Richard Brown, who will receive 17% of the government’s recovery.  USAO ND TX

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

February 19, 2021

Information Innovators Inc. (Triple I), a federal technology contractor in Virginia, has agreed to pay over $6 million to settle claims that a predecessor company knowingly overbilled the Department of Homeland Security (DHS) on an Enterprise Acquisition Gateway for Leading Edge Solutions Contract (EAGLE contract) from 2007 to 2014.  The alleged False Claims Act violations by Creative Computing Solutions Inc. (CCSi) involved billing DHS for work performed by under-qualified CCSi employees at rates reserved for more qualified employees.  DOJ; USAO MD

Tagged in: FCA Federal, Government Procurement Fraud,

February 19, 2021

Antonio Olivera, a hospice administrator in Southern California, has been sentenced to 2.5 years in prison and ordered to pay nearly $2.2 million in restitution for his role in a multimillion dollar fraud scheme that ran from 2011 to 2018.  Together with three co-conspirators, Olivera paid illegal kickbacks to patient recruiters for referrals of Medicare beneficiaries to the hospice, Mhiramarc Management LLC.  When Mhiramarc staffers realized the referrals did not qualify for hospice, Olivera overruled them and caused the referrals to be put on hospice, ultimately causing Medicare to pay over $17 million in false claims.  DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare,

February 17, 2021

French contractor COLAS Djibouti SARL will pay a total of $14.5 million to resolve claims that it supplied substandard concrete under a contract with the U.S. Navy for construction of Navy airfields in the Republic of Djibouti.  Colas Djibouti was required to certify that concrete supplied met contractual specifications for composition and characteristics, but made fraudulent misrepresentations and created fictitious testing results regarding the concrete’s composition and characteristics.  Defendant entered into a deferred prosecution agreement on criminal claims, paying $12.5 million ($10 million in forfeiture and restitution, and $2.5 million as a criminal penalty).  Defendant also entered into a civil settlement for  $3.9 million, receiving a credit of $1.96 million for its payment under the DPA.  DOJ; USAO SD Cal

Tagged in: Contract Non-Compliance, Criminal Proceedings, Defense Contract Fraud, FCA Federal, Government Procurement Fraud,

February 12, 2021

The operator of Georgia-based durable medical equipment company Wilmington Island Medical Inc. has been sentenced to two years in prison and ordered to pay about $550,000 in restitution for paying kickbacks to doctors and nurse practitioners in exchange for signed orders and then billing those orders to Medicare.  The judgment against Patrick Wolfe is part of an ongoing investigation by the Southern District of Georgia to crack down on more than $1.5 billion in losses to Medicare and Medicaid originating from the district.  So far a total of thirty-one individuals and companies have been charged.  USAO SDGA

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare,

February 4, 2021

Durable medical equipment company Regency, Inc., has agreed to a $20.3 million civil settlement to resolve allegations that, together with its principal Kelly Wolfe, it violated the False Claims Act by creating dozens of front companies to submit over $400 million in false claims to government healthcare programs for the sale of DME that was not medically necessary.  Defendants were alleged to have paid unlawful kickbacks to doctors and falsely claimed that those doctors provided telehealth services to the beneficiaries, when in most cases the doctors had no interaction at all with the beneficiaries.  Wolfe also pleaded guilty to conspiracy to commit healthcare fraud and will be sentenced at a later date.  Former Regency employee Condra Albright will receive 23% of the civil recovery as a whistleblower reward.  DOJ; USAO MD FL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

February 1, 2021

Florida pain clinics Collier Anesthesia Pain, LLC and Tampa Pain Relief Center, Inc., will together pay $1.7 million to resolve claims that they violated the False Claims Act.  The clinics were alleged to have paid unlawful kickbacks to affiliated surgery centers by waiving copayments for surgical facility fees in order to induce patients to receive injection procedures. In addition, the government contended that the clinics improperly billed for evaluation and management services and psychological testing services.  USAO MD FL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud,

January 28, 2021

Electronic health records vendor athenahealth Inc. will pay $18.25 million to resolve claims brought in two separate whistleblower actions alleging that certain Athena marketing programs provided unlawful remuneration to healthcare providers and others to induce providers to purchase Athena’s EHR systems.  Remuneration to current and prospective customers included all-expenses paid trips to sporting, entertainment, and recreational events, as well as cash payments to customers who referred others to Athena.  In addition, Athena paid other EHR vendors who referred clients to Athena when they were discontinuing their own EHR products and services. The kickbacks allegedly improperly generated sales for Athena while causing healthcare providers to submit false claims to the federal government for incentive payments related to the adoption and “meaningful use” of Athena’s EHR technology. The whistleblowers, Geordie Sanborn, Cheryl Lovell, and William McKusick, will receive a share of the total settlement that remains to be determined.  DOJ; USAO Mass

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Rewards,

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