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September 25, 2019

Mobile diagnostic service provider Trident USA Health Services LLC has agreed to pay $8.5 million to settle two whistleblower cases alleging violations of the False Claims Act.  Trident’s CIO, Ravi Srivastava, and a regional sales manager, Peter Goldman, had each filed their own qui tam suits alleging Trident had been engaged in a kickback scheme with skilled nursing facilities between 2006 and 2019.  For their efforts, Srivastava will receive $2 million and Goldman will receive $106,250 of the government’s recovery.  USAO EDPA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, SNF, Whistleblower Case, Whistleblower Rewards,

September 25, 2019

Dhanabapa LLC, doing business as E-Z Pharmacy, and owner Shardaben Patel have agreed to pay $1.1 million to settle allegations of defrauding Medicare and violating the False Claims Act in billing Medicare for prescription medications that were not actually dispensed.  The fraudulent billing occurred from 2012 to 2016 and included medications such as Advair Diskus, Humalog, Novolog, Renvela, and Lidoderm.  USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

September 18, 2019

Florida-based compounding pharmacy Diabetic Care Rx LLC, also known as Patient Care America, together with two of its executives, CEO Patrick Smith and VP of Operations Matthew Smith, and the private equity firm Riordan, Lewis & Haden Inc., will pay $21.36 million to resolve a case brought by two whistleblowers under the False Claims Act alleging that they paid unlawful kickbacks to secure referrals for patients covered by TRICARE, the federal healthcare program that covers military members and their families.  The pharmacy paid patient recruiters to target military members and their families for the prescription of compounded creams and vitamins formulated to ensure the highest possible reimbursement from TRICARE.  The marketers in turn paid doctors who issued the prescriptions, often without seeing or even speaking to the purported patients.  In addition, the pharmacy and marketing company often covered patient copayments through a sham charitable organization affiliated with the marketing company.  Private equity investor RLH was alleged to have known about and agreed to the kickback scheme.  Whistleblowers Marisela Medrano and Ada Lopez were, respectively, the former Director of Marketing and the Reimbursement Services Manager of PCA.  They will receive a yet-to-be-determined share of the U.S. recovery.  DOJ; SD FL

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Defendants, FCA Federal, Other Government Health Programs, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

September 17, 2019

Physician Alliance Ltd. (PAL) and its medical director agreed to pay $178,000 to resolve False Claims Act allegations for improperly billing Medicare for providing patients with electric acupuncture medical devices that is affixed behind patients' ears. Since Medicare does not reimburse for acupunctural devices, PAL allegedly billed Medicare for the “implantation of neurostimulator electrodes,” a procedure that requires surgery and for which Medicare reimburses in the thousands of dollars. The case was investigated out of the Eastern District of Pennsylvania. DOJ

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

September 13, 2019

Texas hospital administrator Starsky Bomer was convicted of violating the Anti-Kickback Statute and conspiring to commit healthcare fraud for paying kickbacks to group homes and others in exchange for referrals to outpatient treatments for severe mental illness at his affiliated hospital, resulting in $16 million dollars of false claims to Medicare. The kickbacks came in the form of salary payments and payments for transportation to owners of group homes. Mr. Bomer was sentenced to ten years in prison for his involvement in the scheme. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Hospital Fraud, Medicare,

September 12, 2019

New Jersey doctor Joseph DeCorso pleaded guilty to fraudulently prescribing orthotic braces over the phone for two telemedicine companies, resulting in a $13 million loss to Medicare. Dr. DeCorso admitted that the telemedicine companies preyed on elderly and disabled Medicare beneficiaries, on behalf of whom he submitted orders for medically unnecessary braces. He prescribed these braces without ever speaking to or consulting with these patients. The case was investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General. DOJ

Tagged in: Lack of Medical Necessity, Medicare,

September 9, 2019

Dr. Augusto Castrillon of Texas has agreed to pay $2 million to settle allegations he fraudulently billed Medicare for medically unnecessary diagnostic tests in violation of the federal False Claims Act.  From 2009 to 2015, the owner and operator of Castrillon Family Clinic allegedly submitted false claims for transcranial doppler imaging studies, electromyography, nerve conduction studies, and autonomic function testing that were ordered for the same patients on a recurring basis.  The claims submitted by Dr. Castrillion were so excessive that they stood out as a significant statistical outlier in a proactive review of claims data by the U.S. Attorney’s Office.  USAO SDTX

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

September 5, 2019

Dentist Santa Maria McKibbens has agreed to pay North Carolina $375,000 to resolve allegations that she submitted false claims to the North Carolina Medicaid Program by billing for dental restorations that were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy.  NC

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

September 4, 2019

Pharmaceutical company Mallinckrodt ARD LLC has agreed to pay $15.4 million to settle allegations of violating the Anti-Kickback Statute by “wining and dining” healthcare providers to induce Medicare prescriptions of its drug H.P. Acthar Gel.  The allegations arose from two whistleblowers, who will jointly receive about $2.9 million of the settlement.  DOJ

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

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