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December 19, 2018

A vascular surgeon and his practice group, Dr. Irfan Siddiqui and the Heart and Vascular Institute of Florida (HAVI), have agreed to pay $2.23 million to settle a False Claims Act brought by a whistleblower, Lois Hawks, who had been a patient of the doctor.  Defendants were alleged to have submitted false claims for vein ablation services that were not medically necessary, were performed by unqualified personnel, or were based on medical records containing false diagnoses and symptoms.  In addition, defendants were alleged to have upcoded evaluation and management service claims.  Ms. Haws will receive a relator's share of $446,000.  USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

December 18, 2018

After submitting more than $3.5 million in false Medicare claims for home health services, John Dubor of Sugar Land, Texas, has been sentenced to nine years in prison and ordered to pay $3.5 million in restitution.  Through his company, Care Committers Health Services, Dubor paid marketers and group home owners for Medicare beneficiary information, then falsely billed Medicare and Medicaid for home health services for which the beneficiaries did not qualify, did not receive, or both.  Dubor himself would falsify patient assessment forms to make patients appear sicker, entitling him to higher reimbursement rates, and instructed his employees to falsify certifications and forge physician signatures.  USAO SDTX

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

December 14, 2018

Crossroads Hospice of Kansas has agreed to pay $300,000 for violating the Kansas False Claims Act. Under that law, once a healthcare provider is alerted to charges improperly submitted to the state's Medicaid program, it is obligated to refund the reimbursement in a timely manner or risk prosecution. In the case of Crossroads, the provider had failed to refund money paid on behalf of improperly certified beneficiaries. KS AG

Tagged in: FCA State, Home Health and Hospice, Lack of Medical Necessity, Medicaid,

December 13, 2018

Hospice care provider SouthernCare, Inc. has agreed to pay $5,863,426 for submitting fraudulent claims to Medicare between 2009 to 2014. Under Medicare's eligibility rules, in order for hospice care to be reimbursed, a patient must have a life expectancy of six months or less as certified by a physician, and terminal illnesses must be documented with appropriate records. However, according to qui tam complaints by former employees Dawn Hamrock and Patricia Beegle, SouthernCare billed Medicare for care provided to patients who were not Medicare eligible or who had no proof of Medicare eligibility. As part of the settlement, Hamrock and Beegle will share a $1.1 million whistleblower reward. USAO EDPA

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

December 11, 2018

Target Corp. will pay $3 million to settle allegations that it improperly billed and received payments from the state’s Medicaid program (MassHealth). Between August 2009 and July 2015, at their Massachusetts locations, Target allowed auto-refills on prescriptions that were not clearly requested by a MassHealth patient or caregiver at the time of refill. The investigation arose from a qui tam action by an unnamed whistleblower in the United States District Court for the District of Minnesota. Mass AG  

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 11, 2018

A New York-based audiology practice has agreed to pay $566,263.08 in connection with alleged violations of the False Claims Act and Anti-Kickback Statute. According to an unnamed whistleblower, Oviatt Hearing and Balance, LLC improperly billed Medicare and TRICARE for services rendered by unlicensed and unsupervised employees, as well as provided inappropriate inducements in the form of free iPads, Butterball turkeys, and gift cards, to Medicare and TRICARE beneficiaries to get them to choose Oviatt over other providers. For their role in exposing the fraud, the whistleblower stands to receive a relator's share of $120,000. USAO NDNY

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

December 11, 2018

Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act in claims submitted to Medicare, Medicaid, and federal employee health insurers. From 2007 until 2014, under DiIorio's direction, Coordinated Health allegedly exploited a billing code called Modifier 59 in order to separately bill for orthopedic surgery charges that, properly billed, instead fall under a single "global" payment for each surgery. Even after outside consultants warned company executives about the improper practice in 2011 and 2013 and provided on-site training on the proper use of Modifier 59, Coordinated Health continued making false claims, causing federal healthcare payers to overpay by millions of dollars. As part of the settlement, the company has signed a Corporate Integrity Agreement for additional government oversight into its billing practices over the next five years. USAO EDPA

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs,

December 4, 2018

Dermatology Associates of Central New York, PLLC has agreed to pay $811,196.88 to settle claims that it overcharged Medicaid, Medicare, and TRICARE by falsely submitting claims under physicians' names, in violation of both the federal and New York False Claims Acts. A whistleblower complaint revealed that many of the physicians named on invoices were not in the office the day care was provided and could not have supervised in the rendering of services, and that some of the non-physician practitioners who provided care were not licensed to do so in the state of New York. As a result of bringing the fraud to light, the unnamed whistleblower will receive $138,000. USAO NDNY

Tagged in: FCA Federal, FCA State, Improper Medical Personnel, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 3, 2018

Feng Qin, M.D., a vascular surgeon who in 2015 settled claims that he performed medically-unnecessary vascular surgeries, has again been charged with such unlawful practices.  As reported by an unidentified whistleblower who brought a case under the False Claims Act, Qin routinely scheduled patients for surgeries months in advance, regardless of whether there was a justifiable clinical reason for the surgery.  At times, Qin would alter medical records.  Qin would then bill Medicare for these procedures, despite his knowledge that procedures on patients that are not medically reasonable and necessary are not covered by Medicare.  USAO SDNY

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

November 27, 2018

Twelve individuals have been charged by a federal grand jury in a 22-count indictment related to a multi-year conspiracy to defraud the Pennsylvania Medicaid Home Care Program. The indictment lists a multitude of fraudulent acts by the defendants, alleging that they: submitted false claims for services that were not provided, misused consumers’ personal identifying information, provided false documentation during state audits, and even submitted claims to Medicaid for home care services for consumers who were hospitalized or no longer alive. Ten of the defendants reside in Western Pennsylvania, one is a resident of Georgia, and the twelfth defendant is a resident of South Carolina. Between January 2011 and April 2017, the conspirators, who owned and operated the home health care companies, received more than $87,000,000 in Medicaid payments.  The conspiracy and health care fraud charges each carry a maximum total sentence of 10 years in prison, a fine of $250,000, or both.  DOJ

Tagged in: Criminal Proceedings, FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

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