Archive

October 26, 2015

Valentina Kovalienko, the owner of two Brooklyn medical clinics, pleaded guilty to, and agreed to forfeit almost $30 million for, her role in a $55 million health care fraud and money laundering conspiracy. According to her admissions, from approximately February 2008 to February 2011, Kovalienko and others executed a scheme in which patients were paid cash kickbacks to subject themselves to medically unnecessary physical and occupational therapy, diagnostic tests and office visits that were not performed by licensed professionals, and for which the clinics billed Medicare and Medicaid. Kovalienko also admitted that to support the fraudulent claims she paid occupational and physical therapists to falsify patient charts and billing records. DOJ

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

October 19, 2015

Millennium Health (formerly Millennium Laboratories) agreed to pay $256 million to the federal and state governments to resolve charges it billed Medicare for medically unnecessary urine drug and genetic testing. According to the government, Millennium caused physicians to order excessive numbers of urine drug tests, in part through the promotion of “custom profiles,” which instead of being tailored to individual patients were in effect standing orders that caused physicians to order large number of tests without an individualized assessment of each patient’s needs. The government further alleged that Millennium’s provision of free point of care urine drug test cups to physicians — expressly conditioned on the physicians’ agreement to return the urine specimens to Millennium for hundreds of dollars’ worth of additional testing — violated the Stark Law and the Anti-Kickback Statute. The case originated from several whistleblower lawsuits filed under the qui tam provisions of the False Claims Act. Whistleblowers in the underlying cases will receive awards totalling roughly $32 million. DOJ GA , FL, WA

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

October 16, 2015

A federal jury in Los Angeles convicted Amalya Cherniavsky and her husband, Vladislav Tcherniavsky, for conspiracy to commit health care fraud in connection with a $1.5 million Medicare fraud scheme. The evidence at trial demonstrated that Cherniavsky owned JC Medical Supply, a purported durable medical equipment supply company, and that she co-operated the company with her husband, Tcherniavsky, and that they paid illegal kickbacks to patient recruiters in exchange for patient referrals. The evidence further showed that the defendants paid kickbacks to physicians for fraudulent prescriptions – primarily for expensive, medically unnecessary power wheelchairs – which the defendants then used to support fraudulent bills to Medicare. DOJ

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

October 15, 2015

Shreveport, Louisiana community mental health center Westwood Mental Health LLC, and its parent company MedSouth LLC, agreed to pay $3.5 million to settle False Claims Act and Anti-Kickback Statute allegations that Westwood falsified patient records, billed for services not medically necessary, billed for services that were not rendered, provided bribes to Medicare beneficiaries who did not qualify for partial hospitalization services and provided bribes and/or kickbacks to employees to further or conceal the fraud. DOJ (WDLA)

Tagged in: Anti-Kickback and Stark, FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

October 14, 2015

Santiago Borges, Erik Alonso and Cristina Alonso, all of Miami, pleaded guilty to federal healthcare fraud charges. Borges owned the now-defunct mental health centers R&S Community Mental Health Inc. and St. Theresa Community Mental Health Center Inc., and was an investor in New Day Community Mental Health Center LLC . Erik Alonso was the clinical director of all three centers. Cristina Alonso was a therapist at R&S. They admitted the clinics billed Medicare for costly partial hospitalization program services that were not medically necessary or not provided to patients. Borges also admitted he paid kickbacks to patient recruiters who, in exchange, referred beneficiaries to the centers. DOJ

Tagged in: Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Provider Fraud, Upcoding,

October 9, 2015

Cincinnati-based West Chester Hospital and its parent company, UC Health, agreed to pay $4.1 million to settle allegations that West Chester Hospital violated the False Claims Act by billing federal health care programs for medically unnecessary spine surgeries. The challenged surgeries were performed between 2009 and 2013 by Dr. Abubakar Atiq Durrani, a surgeon from Mason, Ohio, who had admitting privileges at West Chester Hospital and who was arrested in July 2013 but allegedly fled the country and remains a fugitive. The allegations first arose in a whistleblower lawsuit filed by former patients of Durrani under the qui tam provisions of the False Claims Act. They will receive a whistleblower award of approximately $800,000 from the federal share of the settlement. DOJ

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

October 8, 2015

Evelio Fernandez Penaranda, owner of Miami-based Naranja Pharmacy Inc., was sentenced to 46 months in prison and to pay $1,876,241 in restitution for his role in the submission of more than $1.8 million in fraudulent claims to Medicare. According to his guilty plea, Naranja Pharmacy submitted fraudulent claims to Medicare for prescription drugs not prescribed by physicians, not medically necessary and not provided to Medicare beneficiaries. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud,

October 2, 2015

Guardian Hospice of Georgia LLC, Guardian Home Care Holdings Inc.and AccentCare Inc. agreed to pay $3 million to resolve allegations they knowingly submitted false claims to Medicare for hospice patients who were not terminally ill. The allegations originated in a whistleblower lawsuit filed by former Guardian employees Rose Betts and Jennifer Williams under the qui tam provisions of the False Claims Act. Ms. Betts and Ms. Williams will receive a whistleblower award of approximately $510,000. DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

October 1, 2015

Nurses’ Registry and Home Health Corporation and the Estate of its former owner, the deceased Lennie House, agreed to pay $16 million to resolve allegations that Nurses’ Registry, at the direction of Lennie House, violated the False Claims Act by fraudulently billing Medicare for medically unnecessary home health services and for services tainted by kickbacks provided by the company and House to local physicians and others who referred patients to Nurses’ Registry. According to the government, Nurses’ Registry falsified medical records to make it appear as if patients had a medical need for skilled nursing or therapy services, or appear as if the patients were homebound. In addition to billing Medicare for unnecessary or non-reimbursable home health services, Nurses’ Registry and House provided tickets to athletic events and concerts, and provided other things of value, to doctors and referral sources in order to induce or reward patient referrals. The allegations originated in a whistleblower lawsuit filed by former employees Alisia Robinson-Hill and David Price under thequi tam provisions of the False Claims Act. They will receive a yet-to-be-determined whistleblower award from the settlement proceeds. DOJ (KY)

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

September 29, 2015

Delaware-based St. Francis Hospital agreed to pay roughly $4 million to the US and $200,000 to the State of Delaware to resolve charges it violated the False Claims Act by improperly billing Medicare and Medicaid for patients admitted into its inpatient rehabilitation unit in Wilmington, Delaware between 2007 and 2010, when admission was not medically necessary and/or the services provided did not fully qualify for reimbursement. The settlement agreement also resolves separate allegations that St. Francis employed an individual who was excluded from participating in any Federal health care programs. DOJ (DE)

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

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