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April 18, 2017

International Tutoring Services, LLC (d/b/a Hospice Plus; Goodwin Hospice, LLC; Phoenix Hospice, LP; Hospice Plus, L.P.; and Curo Health Services, LLC) agreed to pay $12.21 million to resolve allegations they violated the False Claims Act by paying kickbacks in exchange for patient referrals. The alleged kickbacks took the form of cash, gift cards, sham loans, a free equity interest in another entity, stock dividends, and free rental space. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblowers will receive a whistleblower award from the proceeds of the government's recovery. DOJ (NDTX)

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Whistleblower Case, Whistleblower Rewards,

March 30, 2017

Godwin Oriakhi, owner of five Houston-area home health agencies pleaded guilty to conspiring to defraud Medicare and the State of Texas’s Medicaid-funded Home and Community-Based Service and Primary Home Care programs of more than $17 million.  According to his plea, Oriakhi admitted that he, his daughter and co-defendant Idia Oriakhi, and other members of his family owned and operated: Aabraham Blessings LLC, Baptist Home Care Providers Inc., Community Wide Home Health Inc., Four Seasons Home Healthcare Inc. and Kis Med Concepts Inc., and that they obtained patients for these home health agencies by paying illegal kickback payments to patient recruiters and his office employees for hundreds of patient referrals.  Oriakhi also admitted that they paid Medicare and Medicaid patients by cash, check, Western Union and Moneygram for receiving services from his family’s home health agencies in exchange for the ability to use their Medicare and Medicaid numbers to bill the programs for home healthcare. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Medicaid,

March 2, 2017

Detroit-area physician Aaron Goldfein pleaded guilty for his role in a $5.4 million Medicare fraud scheme involving phony physician visits and drug prescriptions.  As part of his plea, Goldfein admitted to being part of a scheme in which his co-conspirators would hold themselves out as licensed physicians and purport to perform physician home visits and other services for Medicare beneficiaries, although these co-conspirators were not licensed to practice medicine in Michigan.  Goldfein would then bill Medicare through Tri-City Medical Center as if he himself had completed these visits.  Goldfein also admitted to being part of a scheme in which he received kickbacks in exchange for writing home health prescriptions. DOJ

Tagged in: Anti-Kickback and Stark, Medical Billing Fraud, Medicare,

March 2, 2017

Miami residents Mildrey Gonzalez and Milka Alfaro pleaded guilty to fraud charges stemming from their roles in a $20 million home health care fraud scheme.  Gonzalez and Alfaro were co-owners of seven home health care agencies:  Inar Home Care Service Corp., MA Home Health Inc., Golden Home Health Care Inc., Nova Home Health Care Inc., Finetech Home Health Inc., Homestead Home Health Care LLC and Metro Dade Home Health Inc.  Gonzalez and Alfaro admitted paying bribes and kickbacks to medical professionals in return for the provision of prescriptions for home health care services and referrals of Medicare beneficiaries to their home health care agencies. DOJ

Tagged in: Anti-Kickback and Stark, Home Health and Hospice,

February 24, 2017

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc., two Miami-area home health agencies, was sentenced to a 126 month prison term for his role in a $2.5 million Medicare fraud scheme.  The evidence at trial showed that Leon and his co-conspirators used the companies to submit false claims to Medicare based on services not medically necessary, not actually provided, and for patients procured through the payment of illegal kickbacks to doctors and patient recruiters.  DOJ

Tagged in: Anti-Kickback and Stark, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

February 9, 2017

University Behavioral Health of El Paso agreed to pay $860,000 to resolve allegations it violated the False Claims Act by submitting false claims to Medicare tainted by the payment of kickbacks to a physician under the guise of a professional services agreement in return for the physician’s referral of patients to the hospital.  Specifically, the physician received payments above fair market value, or for services not rendered, and made improper referrals to the hospital for Medicare-reimbursed services.  DOJ (WDTX)

Tagged in: Anti-Kickback and Stark, FCA Federal, Medicare,

January 19, 2017

Nationwide retail pharmacy operator Walgreen Co. agreed to pay $50 million to settle charges it violated the False Claims Act and the Anti-Kickback Statute by enrolling hundreds of thousands of beneficiaries of government healthcare programs in its Prescription Savings Club program by inducing them with discounts and other monetary incentives. According to the government, Walgreens understood that allowing government beneficiaries to participate in the program was a violation of the Anti-Kickback Statute but nevertheless marketed the program to them anyway and paid its employees bonuses for each customer they enrolled in the program, without verifying whether the customers were government beneficiaries. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (SDNY)

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

January 12, 2017

Idia Oriakhi, the administrator of five Houston-area home health agencies, pleaded guilty to conspiring to defraud the State of Texas’ Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. Oriakhi’s parents owned and operated Aabraham Blessings, LLC; Baptist Home Care Providers, Inc.; Community Wide Home Health, Inc.; Four Seasons Home Healthcare, Inc. and Kis Med Concepts, Inc. and admitted that she, her father Godwin Oriakhi and others obtained patients for her family’s home health agencies by paying illegal kickback payments to patient recruiters and physicians for referring and certifying Medicaid patients for services not medically necessary and often not provided. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

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