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January 22, 2021

The estate of Dr. Patrick T. Hunter has agreed to pay more than $1.7 million to resolve allegations that the urologist, who passed away in 2019, submitted false claims to Medicare and TRICARE for medically unnecessary procedures and received improper payments for them from the Orlando Center for Outpatient Surgery.  Between 2010 and 2016, Dr. Hunter allegedly performed the lithotripsy procedures, which break up kidney stones, on patients who either did not have kidney stones or were not medically indicated for them.  For initiating the successful qui tam suit, whistleblower Scott Thompson will receive a relator’s share of $385,000.  USAO MDFL

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

January 19, 2021

Texas-based Allstate Hospice LLC and Verge Home Care LLC and their founders, Onder Ari and Sedat Necipoglu, have paid over $1.8 million to resolve allegations of submitting claims to Medicare that were tainted by improper inducements.  In violation of the Physician Self-Referral Law and False Claims Act, the defendants allegedly set up monthly payments to referring physicians through sham medical directorship agreements, sold interests to five referring physicians in order to provide them with substantial quarterly dividends, and provided other referring physicians with free tickets and travel.  USAO SDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, Provider Fraud,

January 15, 2021

The co-owner of multiple compounding pharmacies and pharmaceutical distributors in Mississippi has been sentenced to 18 years in prison and ordered to pay over $287 million in restitution and over $56 million in forfeiture after pleading guilty to healthcare fraud and money laundering.  As part of his guilty plea, Wade Ashley Walters admitted to being the mastermind behind a four-year scheme that defrauded TRICARE and private health benefit programs of over $287 million.  To perpetuate the fraud, Walters and his co-conspirators solicited and paid recruiters to procure prescriptions for highly reimbursed compounded medications, solicited and paid physicians to authorize prescriptions for same, adjusted prescription formulas to ensure the highest reimbursement possible, and improperly waived or reduced mandatory beneficiary copayments.  USAO SDMS

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

January 12, 2021

Boeing-owned drone maker Insitu Inc. has agreed to pay $25 million to resolve a whistleblower-brought suit alleging violations of the False Claims Act.  According to D.R. O’Hara, a former executive at Insitu, the company knowingly submitted cost and pricing data for new parts, but used recycled parts to build drones being supplied to the U.S. Navy and U.S. Special Operations Command on seven contracts.  The alleged misconduct ran from 2009 to 2017.  For exposing the fraudulent scheme, Mr. O’Hara will receive $4.6 million of the settlement proceeds.  USAO WDWA

Tagged in: Defense Contract Fraud, FCA Federal, Whistleblower Case, Whistleblower Rewards,

January 11, 2021

California-based AutoGenomics, Inc. has agreed to pay over $2.5 million to settle allegations of submitting kickback-tainted claims to Medicare.  Between 2013 and 2015, AutoGenomics allegedly paid kickbacks to a healthcare marketing company for each genetic test performed by AutoGenomics’ former laboratory, PersonalizeDxLabs.  The kickbacks were only paid if the claims were reimbursed by Medicare.  Pursuant to the agreement, the company linked up with Prestige Administrative Services, LLC, which owns and operates residential nursing homes in multiple states, to identify and obtain samples from Prestige’s Medicare patients to send to PersonalizeDxLabs, in violation of the Anti-Kickback Statute and the False Claims Act.  USAO WDWI

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

January 11, 2021

Defense contractor Raytheon Technologies Corporation and its subsidiary, Hamilton Sundstrand Corporation, have agreed to pay over $515,000 to settle allegations of submitting false claims for payment.  Between 2006 and 2015, Raytheon and Hamilton improperly certified that goods it sold either directly to the government or to suppliers selling to the government were of domestic origin, when in fact they were manufactured in Romania.  The false certifications violated the contracts’ domestic-preference requirements, the Buy American Act of 1933, and the False Claims Act.  USAO CT

Tagged in: Certifications, Defense Contract Fraud, FCA Federal, Government Procurement Fraud, Trade Agreements,

January 8, 2021

Ducci Electrical Contractors, Inc. has agreed to pay more than $3.2 million to resolve criminal and civil charges alleging fraud on two public construction contracts in Connecticut that were largely funded by the U.S. Department of Transportation’s Disadvantaged Business Enterprise (DBE) program.  The two contracts—one from 2007 that was valued at over $79 million, and the other from 2012 that was valued at nearly $7 million—Ducci indicated that it would subcontract with a particular DBE at 13% and 12% respectively.  However, in violation of the terms of the program, Ducci controlled most of the decisions made by the DBE, preventing the DBE from performing a commercially useful function on either contract, and falsely submitted to the government that the DBE had performed the work.  USAO CT

Tagged in: Criminal Proceedings, FCA Federal, Government Programs Fraud,

January 6, 2021

Exceltox, a genetic testing laboratory in California, has agreed to pay $357,584 to resolve allegations of submitting false claims to Medicare over two months in 2015.  With the help of a New Jersey-based contractor named Seth Rehfuss, Exceltox allegedly performed genetic tests on seniors in New Jersey-based senior housing complexes without proper orders from a treating physician, then submitted claims to Medicare for these tests.  For his role in the fraud, Rehfuss was sentenced to over 4 years in prison in 2019.  USAO NJ

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare,

January 4, 2021

Three providers, James P. Anderson, as owner of Affiliated Neurologists, PLC; Charles F. Spencer, as owner of Total Family Physicians Center PLLC; and Mitchell P. Shea, as owner of Chiro2Med of Tennessee P.C., have agreed to pay the United States and Tennessee a total of $1.72 million to resolve allegations under the False Claims Act for improperly billing Medicare and TennCare for “P-Stim” electro-acupuncture devices that do not qualify for reimbursement.  The defendants billed for the disposable P-Stim devices using a code reserved for neurostimulator devices that are implanted during a surgical procedure. USAO MDTN

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

December 31, 2020

Department of Veterans Affairs contractor TriWest Healthcare Alliance Corp. has agreed to pay $179.7 million to resolve allegations that it improperly retained overpayments received from the VA.  TriWest administered portions of VA’s former Veterans Choice Program and its Patient-Centered Community Care Program (PC3), which enable veterans to obtain VA-paid healthcare from private providers.  At times, VA allegedly paid TriWest twice for the same services, or paid for services for which TriWest received full or partial reimbursement from other healthcare providers, and TriWest failed to return those overpayments.  DOJ

Tagged in: FCA Federal, Government Procurement Fraud, Healthcare Fraud, Other Government Health Programs,

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