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August 29, 2019

International SOS Assistance, Inc. and related entities and individuals have agreed to pay $940,000 to resolve claims that they overbilled TRICARE for air medical evacuation services provided to military service members and their families.  International SOS was alleged to have negotiated discounts from third-party air ambulance services, but failed to pass those discounts on to TRICARE.  The case was brought by a whistleblower who used to be a flight desk manager for International SOS; he will receive an award of $165,000.  USAO EDPA

Tagged in: Ambulance, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Other Government Health Programs, Pricing Fraud, Whistleblower Case, Whistleblower Rewards,

August 29, 2019

A healthcare executive in Tennessee has been sentenced to 3.5 years in prison and ordered to forfeit nearly $600,000 for her role in a $4.6 million illegal kickback scheme.  In pleading guilty to violating the Anti-Kickback Statute, Brenda Montgomery admitted that she paid the CEO of Comprehensive Pain Specialist (CPS), John Davis, a 60% cut of Medicare reimbursements—amounting to more than $770,000—for arranging the referrals of durable medical equipment.  As a result of the scheme, Montgomery herself received fraudulent reimbursements amounting to as much as $2.9 million.  USAO MDTN

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

August 27, 2019

Three doctors and a cardiac center have agreed to pay a combined $1.1 million to resolve allegations of receiving kickbacks from the now defunct Northwest Medical Testing Company (NMTC) in exchange for ordering genetic tests from NMTC that were then billed to Medicare.  Dr. Gregory Sampognaro will pay $519,750, Dr. Isabella Strickland will pay $107,900, Dr. Warren Strickland will pay $95,053, and Cardiology P.C. will pay $411,300.  USAO WDWA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Medicare,

August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million.  According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals.  As part of the settlement, Seddon will receive a $200,000 relator’s share.  USAO SDAL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 15, 2019

North Carolina ambulance company Gate City Transportation has been ordered to pay $5.25 million in restitution for falsely billing the state's Medicaid program for convalescent ambulance services when, in fact, the company was providing only medical van service to ambulatory and wheelchair-bound patients.  During the investigation, agents confiscated more than $5 million in cash and property, which will be applied to the restitution.  USAO MD NC

Tagged in: Ambulance, Criminal Proceedings, Healthcare Fraud, Medicaid,

August 8, 2019

California-based Beaver Medical Group LP and one of its physicians, Dr. Sherif Khalil, have agreed to pay $5 million to resolve allegations of violating the False Claims Act.  According to another physician formerly employed at Beaver, the defendants allegedly submitted false diagnoses to Medicare Advantage Organizations (MAOs) for the Medicare beneficiaries under its care, which caused Medicare to pay a needlessly inflated rate of reimbursement.  The whistleblower, Dr. David Nutter, will receive a relator’s share of $850,000 from the settlement proceeds.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

August 2, 2019

A Georgia man accused of masterminding a fraud scheme against TRICARE has been sentenced to 8 years in prison and ordered to pay a combined $8 million in restitution and forfeiture.  Coordinated by Michael Burton, the scheme ran from 2014 to 2015 and involved multiple co-defendants and a Florida-based pharmacy.  Together, their cumulative actions caused TRICARE to spent millions of dollars on medically unnecessary compounded prescription drugs, and earned Burton over $1.4 million in commissions.  USAO NDFL

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

August 1, 2019

Tennessee-based telemarketer Scott Roix and his companies have agreed to pay $2.5 million to settle two whistleblowers’ False Claims suit alleging the submission of false claims to Medicare, TRICARE, and other federal health benefit programs.  Roix and his companies allegedly procured fraudulent insurance information from patients around the country in order to arrange prescriptions for medically unnecessary pain creams; they then sold these prescriptions to pharmacies, labeling proceeds as earned through marketing services.  The whistleblowers in this case, Jennifer Silva and Jessica Robertson, will receive $287,500 for revealing the fraudulent scheme.  USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

July 24, 2019

Pennsylvania-based Eagleville Hospital has agreed to pay $2.85 million to settle allegations of defrauding Medicare, Medicaid, and the Federal Employees Health Benefits Program.  According to an anonymous relator, Eagleville violated the False Claims Act between 2011 and 2018 by submitting claims for substance abuse patients improperly admitted for high paying, hospital-level detoxification treatments.  The whistleblower will receive $500,000 of the recovery.  USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Other Government Health Programs, Upcoding, Whistleblower Case, Whistleblower Rewards,

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