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Page 35 of 129

September 23, 2020

Gilead Sciences, Inc. has agreed to pay $97 million to resolve claims of paying kickbacks to Medicare beneficiaries in connection with its pulmonary arterial hypertension drug, Letairis.  From 2007 to 2010, Gilead enticed beneficiaries to purchase Letairis by allegedly referring the beneficiaries to a foundation, Caring Voice Coalition (CVC), and then making payments to CVC to cover patient copays of Letairis specifically, in violation of the Anti-Kickback Statute and Medicare rules.  Additionally, Gilead routinely obtained data from CVC that it used to inform future payments, including how many CVC clients were on Letairis, how much CVC spent on those clients, and how much CVC expected to spend on them in the future.  DOJ; USAO MA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Part D, Pharma Fraud,

September 22, 2020

Contractors Bechtel National Inc., Bechtel Corporation, AECOM Energy & Construction, Inc., and Waste Treatment Completion Company, LLC will pay $57.75 million to resolve claims that they violated the False Claims Act by overbilling the Department of Energy for work on the Hanford Waste Treatment Plant.  The investigation was initiated by four whistleblowers who reported overcharging by defendants on craft labor performed by electricians, millwrights, pipefitters, and other skilled trades workers, including billing for unallowable and unreasonable idle time caused by management failures in scheduling work.  The whistleblowers will receive $13.75 million from the settlement.  USAO ED WA

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

September 21, 2020

Neurosurgical Care LLC, its medical director Sagi Kuznits, and its practice director Pnina Kuznits, will pay over $1 million to resolve claims that they overbilled Medicare, TRICARE, and the Federal Employees Health Benefits Program, for the implantation of neuro-stimulators.  Defendants improperly billed the non-surgical application of P-Stim and Stivax devices as surgical procedures, and improperly billed for the application of an eVox device which was not approved for Medicare reimbursement.  USAO ED PA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Off-Label and Unapproved Use, Provider Fraud,

September 11, 2020

The Scripps Research Institute will pay $10 million to settle claims that overcharged the National Institutes of Health under research grants.  Under the terms of the grants, recipients may only use grant funds on tasks that specifically relate to the funded project.  Defendant was alleged to have an inadequate system for tracking researcher time and expenses, resulting in improper charges to the government for costs unrelated to funded projects, including time spent writing new grant applications, teaching, and engaging in other administrative activities. Former Scripps employee Thomas Burris, Ph.D., will receive $1.75 million as a whistleblower reward.  DOJ; USAO MD

Tagged in: FCA Federal, Grant and Research Fraud, Whistleblower Case, Whistleblower Rewards,

September 10, 2020

Shreveport Prosthetics, Inc. will pay $1.6 million to resolve claims in an action brought by the company’s former office administrator, Kimberly Throgmorton, under the qui tam provisions of the False Claims Act.  The company was alleged to have submitted false bills to Medicare by using the supplier number of a different company after its own supplier number was deactivated, and by routinely waiving patient co-payments.  Ms. Throgmorton will receive over $250,000 as a whistleblower reward.  USAO WD LA

Tagged in: FCA Federal, Medical Billing Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

September 10, 2020

Asphalt contractor Dave O’Mara Contractor, Inc. will pay $4.25 million to resolve claims that in performing and billing for repaving work that was funded in part by the Federal Highway Administration, they falsely represented that they were including steel slag in the asphalt mixture when they were not in fact doing so, increasing the chance that the roads would prematurely deteriorate. DOJ; USAO SD IN

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud,

September 9, 2020

Southern California radiology facility operators William M. Kelly Inc. and Omega Imaging Inc. paid $5 million to resolve claims initiated by a qui tam action under the False Claims Act filed by former employee Syd Ackerman.  The action alleged that defendants submitted claims for CT scans and MRIs involving contrast injections that were not supervised by a physician as required by applicable program rules.  The whistleblower will receive $925,000 of the settlement.  DOJ

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

September 9, 2020

West Virginia-based acute care hospital, Wheeling Hospital, Inc., has agreed to pay $50 million to resolve claims of violating the Anti-Kickback Statute, Physician Self-Referral (Stark) Law, and False Claims Act.  According to a former executive turned whistleblower, Louis Longo, Wheeling knowingly provided referring physicians with compensation above fair market value, based on the volume or value of their referrals, then submitted claims resulting from those improper referrals to Medicare.  As part of the settlement, Longo will receive a $10 million relator’s share.  DOJ; USAO WDPA; USAO NDWV

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

September 3, 2020

Two affiliates of Independence Blue Cross, Keystone Health Plan East, Inc. and QCC Insurance Company, Inc., which offer Part C Medicare Advantage plans, agreed to pay $2.25 million to resolve allegations that they overstated their costs when they submitted bids to CMS for contract years 2009 and 2010.  As a result, CMS reimbursed them at at an inflated rate.  The matter was initiated by the filing a qui tam complaint under the False Claims act by Eric Johnson, who will receive $500,000 from the recovery.  USAO EDPA

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

August 31, 2020

CDM Smith Inc. and CDM Federal Programs Corporation paid $5.6 million to resolve charges that they violated the False Claims Act and Truth in Negotiations Act by submitting inaccurate cost and labor hour estimates and related certifications in connection with task orders on a federal contract to supply architect-engineering services to Navy bases.  The case was initiated by an unnamed whistleblower, who will receive a share of the recovery.  USAO ED VA

Tagged in: FCA Federal, Government Procurement Fraud, Pricing Fraud, Whistleblower Case,

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