Archive

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 3, 2021

The former CEO of Texas hospice and home health chain the Merida Group, Henry McInnis, has been sentenced to 15 years in prison following his conviction for healthcare fraud and alleged charges. McInnis and his co-conspirator Rondey Mesquias, who was previously sentenced to 20 years in prison, submitted over $150 million in fraudulent Medicare bills between 2009 and 2018 by falsifying medical records and telling thousands of patients with long-term incurable diseases they had less than six months to live in order to enroll the patients in hospice programs for which they were otherwise unqualified. In addition, McInnis directed Merida’s practice of paying physicians bogus “medical director” fees in exchange for those doctors falsely certifying unqualified patients for hospice and home health, as well as paying improper kickbacks to patient recruiters. DOJ

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

February 2, 2021

The owner of Mississippi-based Medworx Compounding and Custom Care Pharmacy, Marco Bisa Hawkins Moran, has been sentenced to ten years in prison and ordered to pay $34.3 million in fines and restitution following his guilty plea on charges related to a conspiracy to defraud TRICARE and other healthcare programs. As part of the scheme, which resulted in the submission of $22.1 million in fraudulent claims, Moran and his co-conspirators adjusted prescription formulas to ensure the highest reimbursement, paid marketers and physicians kickbacks and bribes to obtain prescriptions for high-yield compounded medications without regard to medical necessity, and routinely waived and/or reduced the collection of copayments. USAO SD MS

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, Lack of Medical Necessity, Pharma Fraud,

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,

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 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 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,

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