Archive

May 18, 2016

Missouri physician Randall E. Meyer pleaded guilty to (and agreed to pay roughly $75,000) violating the False Claims Act.  Meyer, a surgeon with Central Missouri Cardiology, P.C., admitted claiming the percentage of patients’ lesions and stenosis in their arteries was 70 percent or greater when it was substantially less.  The health care benefit programs would not have reimbursed claims if the programs had known Meyer was inflating the percentage of patient lesion and stenosis.  DOJ (W.D.MO)

March 15, 2016

Tennessee-based Southern Tennessee Medical Center agreed to pay roughly $2.5 million to settle charges it violated the False Claims Act by submitting Medicare claims for medically unnecessary days of in-patient geriatric psychiatric services and in-patient geriatric psychiatric services for which a Physician Certification or Recertification was not obtained.  DOJ (MDTN)

March 8, 2016

21st Century Oncology Inc., the nation’s largest physician led integrated cancer care provider, and its wholly owned subsidiary South Florida Radiation Oncology agreed to pay $34.7 million to settle charges they violated the False Claims Act by performing and billing for cancer care procedures that were not medically necessary or properly provided. According to the government, the companies improperly billed for Gamma function procedures — which measure radiation doses — under circumstances where there was no medically appropriate purpose for the treatment.  The allegations leading to the settlement originated in a whistleblower lawsuit filed by Joseph Ting, a former physicist at South Florida Radiation Oncology, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of more than $7 million from the proceeds of the government’s recovery.  This settlement follows on the heels of the $19.75 million settlement 21st Century Oncology Inc. subsidiary 21st Century Oncology LLC agreed to pay in December to settle charges of billing for medically unnecessary laboratory urine tests and for paying kickbacks to encourage physicians to order the tests.  Whistleblower Insider

March 7, 2016

Florida businessman David Brock Lovelace was sentenced to 174 months in prison and to pay $2,512,460 in restitution for his role in a multimillion-dollar health care fraud and money laundering scheme.  According to evidence presented at trial, Lovelace and co-conspirators used Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists, three purported medical clinics in Florida, to submit to Medicare more than $12 million in fraudulent claims for radiology, audiology, cardiology and neurology services not rendered by physicians, secured by kickbacks or the subject of forged or falsified documents.  DOJ

March 8, 2016

A Connecticut psychiatrist will pay $404,798 to settle a civil False Claims Act lawsuit alleging that she submitted false claims for payments to Connecticut’s Medicaid program. The state alleged that, from March 2010 to September 2013, while operating a private practice in Mansfield, Dr. Panoor submitted upcoded claims indicating that she provided Medicaid patients with both group counseling and either individual psychotherapy or a detailed examination on the same dates of service when, in fact, she did not provide psychotherapy or detailed examination sessions but instead provided medication management services or a brief meeting with the patient for the purpose of monitoring or changing a patient’s drug prescription – services that are coded, and thus reimbursed, at lower payment rates.

February 19, 2016

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $2.09 million to resolve allegations that patients were administered portions of single-dose vials of chemotherapy drugs that were left over from administrations to prior patients.  The settlement also resolves allegations that some platinum based drugs were administered inappropriately and that certain infusion services were upcoded.  The allegations originated in a whistleblower lawsuit filed by former Adventist employee Heather Huddleston under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $376,452 from the proceeds of the government's recovery.  DOJ (MDFL)

February 12, 2016

New Jersey Doctor Labib E. Riachi and two companies he owns, Riachi, Inc. and Center for Advanced Pelvic Surgery, agreed to pay $5.25 million to resolve allegations they violated the False Claims Act by billing Medicare and Medicaid for anorectal manometry and electromyography diagnostic tests, even though most of the tests were never performed.  The settlement also resolves charges that they submitted claims to Medicare for physical therapy services that should not have been paid because they were not performed by a qualified therapist.  DOJ (NJ)

February 11, 2016

Compounding pharmacies WELLHealth and Topical Specialists and four physicians, Manish Bansal, Mehul Parekh, Marisol Arcila, and Syed Asad, agreed to pay approximately $10 million to resolve allegations they violated the False Claims Act by submitting false claims to TRICARE, the military’s healthcare program.  According to the government, the physicians wrote hundreds of prescriptions for pain and scar creams never used by patients and billed to the government at a cost which yielded up to 90% in profits.  Bansal is a cardiologist at Baptist Hospital; Arcila is a pain management physician at Premier Spine & Pain Center; Asad is a neurologist at Universal Neurological Care; Parekh is a general practice physician at Baptist Hospital.  DOJ (M.D.Fla)

February 9, 2016

Miami physician Henry Lora, medical director of Miami-area clinic Merfi Corporation, pleaded guilty for his role in a Medicare fraud scheme that caused more than $20 million in losses.  Lora admitted that in exchange for kickbacks and bribes, he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided.  Lora and his co-conspirators also falsified patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Isabel Medina, the owner of Merfi, was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ

January 27, 2016

Mohammed Elsaleh, owner and operator of former Houston-area ambulance company National Care EMS agreed to settle allegations that he and the company provided kickbacks to various nursing facilities and hospitals in exchange for rights to the institutions’ more lucrative Medicare and Medicaid transport referrals.  The settlement calls for Elsaleh to pay $125,000 to resolve the “swapping” allegations made against him and the company.  Elsaleh’s brother, Husam Alsaleh, the owner and operator of a successor company also called National Care EMS agreed to pay $120,000 in furtherance of the settlement.  DOJ (SDTX)