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Page 33 of 158

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,

December 21, 2020

DME provider Apria Healthcare Group, Inc. and Apria Healthcare LLC will pay $40.5 million to settle allegations brought in a qui tam action filed by three former Apria employees that they improperly billed government healthcare programs for beneficiary rentals of non-invasive ventilators (“NIVs”) that were not medically necessary or which were provided with improper waivers of patient co-payments.  Medicare pays as much as $1,400 a month for NIVs, and providers are required to monitor patient usage of NIVs and stop billing when the NIVs are no longer being used.  Apria respiratory therapists failed to monitor patient NIV usage and even when Apria knew that patients were no longer using the NIVs, Apria often did not take steps to stop seeking payment.  In addition, Apria sales staff steered doctors and beneficiaries to use NIVs when less-expensive alternatives were available, and routinely waived co-payments for NIV patients without making an assessment of the patient’s financial need.  USAO SDNY; CA AG; FL AG

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case,

December 21, 2020

Substance abuse treatment provider A.R.E.B.A.-CASRIEL, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (“ACI”) and its owner, Steven Yohay, agreed to pay a total of $6 million to resolve federal and New York state claims that they defrauded Medicaid including through the payment of kickbacks and other fraudulent conduct in connection with the enrollment of Medicaid beneficiaries into ACI’s inpatient treatment program.  Defendants allegedly employed drivers who were compensated in part based on the number of patients they recruited, to target homeless individuals to enroll in ACI’s inpatient treatment program by offering food, cash, and money to purchase drugs, and/or alcohol. In addition, ACI unlawfully paid a patient recruiter, and enrolled Medicaid patients who had not been evaluated by a qualified healthcare professional, including by copying a physician’s signature.  The government’s investigation was initiated by a whistleblower complaint filed by a former employee, who will receive an undisclosed amount of the settlement.  USAO SDNY; NY

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 18, 2020

Texas Heart Hospital of the Southwest LLP and its affiliate THHBP Management Company LLC will pay $48 million to resolve claims brought in a whistleblower suit by two of the hospitals’ physicians alleging that the defendants violated the False Claims Act, Stark Law, and Anti-Kickback Statute.  Agreements between the hospital and its physician-owners required the doctors to have 48 patient-contacts a year in order to maintain their ownership interests.  The U.S. did not intervene in the action; the whistleblowers, Dr. Mitchell Magee and Dr. Todd Dewey, will collectively receive $13.92 million, 29% of the total settlement, as a whistleblower reward.  DOJ

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

December 17, 2020

Pharmaceutical company Biogen Inc. agreed to pay $22 million, and specialty pharmacy Advanced Care Scripts agreed to pay $1.4 million, to resolve claims that they conspired to use two foundations, the Chronic Disease Fund and The Assistance Fund, as conduits to pay Medicare co-payments for patients taking Biogen’s MS drugs, Avonex and Tysabri, in violation of the Anti-Kickback Statute.  The government alleged that Biogen coordinated with ACS to time its payments to the foundations and direct its money to cover co-pay costs for patients using its drugs.  DOJ; USAO MA

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Pharma Fraud,

December 16, 2020

Texas resident Rodney Mesquias, the former owner and officer of hospice services provider Merida Group, was sentenced to 20 years in prison following his conviction on fraud charges.  According to the evidence at trial, Mesquias falsely told thousands of individuals and their families that they had less than six months to live, so that he could enroll them in hospice programs, denying them from accessing curative care.  Mesquias also paid kickbacks to physicians for referring patients with long-term diseases such as Alzheimers and dementia.  Over  nearly ten years, Mesquias’ scheme resulted in the submission of $150 million in false and fraudulent claims for medically unnecessary services.  DOJ

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

December 16, 2020

Handicare USA, which manufactures and installs patient lift and mobility systems for healthcare facilities, agreed to pay $800,000 to resolve claims that it knowingly provided products to the Veterans Administration that failed to comply with the Trade Agreements Act.  A whistleblower tipped the government that Handicare patient lifts installed at VA facilities used parts made in China for the mounting system that secured the patient lift to the ceiling, and took steps to conceal its non-compliance, including by instructing that the products should be installed so that the “Made in China” stamps on metal parts would not be visible.  USAO DC

Tagged in: Government Procurement Fraud, Healthcare Fraud, Medical Devices and DME, Trade Agreements,

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