Archive

May 3, 2016

Pennsylvania joined with other states and the federal government in a $306 million civil settlement that resolves allegations that Olympus America, Inc. and some of its subsidiaries paid illegal kickbacks to healthcare providers. The settlement was the result of a whistleblower lawsuit – United States et al., ex rel. John Slowik v. Olympus America, Inc., et al – filed in New Jersey. The lawsuit alleged that Olympus used improper financial incentives to induce doctors and hospital executives to buy a wide ranging array of its endoscopes and other surgical equipment, and to thereby unlawfully increase sales and gain market share. PA, NY

Tagged in: Anti-Kickback and Stark, FCA Federal, Medical Devices and DME, Whistleblower Case,

March 25, 2016

Damian Mayol, the president of Miami-based transportation company Transportation Services Providers Inc. was sentenced to 60 months in prison and to pay $26.8 million in restitution (and forfeit the same amount) for his role in a health care fraud scheme involving three mental health centers that resulted in the submission of approximately $70 million in false Medicare claims. According to evidence presented at trial, Mayol and his co-conspirators used his company to coordinate the payment of illegal kickbacks to recruiters, who in return referred patients to three now-defunct community mental health centers -- R&S Community Mental Health Inc., St. Theresa Community Mental Health Center Inc. and New Day Community Mental Health Center LLC -- for costly partial hospitalization program services that were not medically necessary or not actually provided. DOJ

Tagged in: Anti-Kickback and Stark, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

March 23, 2016

Pennsylvania-based Respironics Inc. agreed to pay $34.8 million to resolve charges it violated the False Claims Act and Anti-Kickback Statute by paying kickbacks in the form of free call center services to durable medical equipment (DME) suppliers that bought its masks for patients with sleep apnea. Respironics allegedly provided DME companies with call center services to meet their patients’ resupply needs at no charge as long as the patients were using masks that Respironics manufactured; otherwise, the DME companies would have to pay a monthly fee based on the number of patients who used masks manufactured by a competitor of Respironics. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Gibran Ameer, who has worked for different DME companies. He will receive a whistleblower award of $5.38 million from the proceeds of the government's recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Medical Devices and DME, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

March 17, 2016

Carlos Medina, owner of Miami-area medical clinics Doral Community Clinic Inc. and Advanced Medical of Doral Inc. was sentenced to 82 months in prison for his role in a Medicare fraud scheme that caused more than $3 million in losses. The clinics purportedly provided medically necessary services to Medicare beneficiaries, but in reality charged cash kickbacks in exchange for prescriptions for home health care services. Some of the beneficiaries who frequented the clinics did not meet Medicare’s criteria for the prescribed services and some of the services prescribed by the medical professionals at Doral and Advanced Medical were never provided by the home health agencies to which the patients were referred. DOJ

Tagged in: Anti-Kickback and Stark, Home Health and Hospice, Medicare,

March 2, 2016

Mark T. Conklin, the former owner and operator of Florida-based Recovery Home Care Inc. and Recovery Home Care Services Inc. (RHC) agreed to pay $1.75 million to resolve charges of violating the False Claims Act by paying illegal kickbacks to doctors who agreed to refer Medicare patients to RHC for home health care services. Conklin sold RHC to National Home Care Holdings in October 2012. According to the government, Conklin ran a scheme under which RHC paid dozens of physicians thousands of dollars per month to serve as sham medical directors who performed little or no work in exchange for referring their patients to RHC. The allegations originated in a whistleblower lawsuit filed by former RHC employee Gregory Simony under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of up to $315,000 from the proceeds of the government's recovery. DOJ

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

March 1, 2016

Olympus Corp. of America, the country’s largest distributor of endoscopes and related equipment, agreed to pay $623.2 million to resolve alleged violations of the False Claims Act and Anti-Kickback Statute through a scheme to pay kickbacks to doctors and hospitals. It is the largest payout ever by a medical device company for violations of the Anti-Kickback Statute. In addition, Olympus subsidiary Olympus Latin America Inc. also agreed to pay $22.8 million to resolve separate charges relating to violations of the Foreign Corrupt Practices Act. The allegations originated in a whistleblower lawsuit filed by John Slowik, Olympus’ former chief compliance officer, under the qui tam provisions of the federal and various state False Claims Acts. He will receive a whistleblower award of roughly $51 million from the proceeds of the government’s recovery. Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, FCPA, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

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

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

January 29, 2016

Amalya Cherniavsky and her husband Vladislav Tcherniavsky, the former owner and former operator of California-based durable medical equipment supply company JC Medical Supply were sentenced for their roles in a $1.5 million Medicare fraud scheme. They were ordered to pay $614,418 in restitution and Tcherniavsky was ordered to serve 51 months in prison. The evidence at trial demonstrated that they paid illegal kickbacks to patient recruiters in exchange for patient referrals and 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, Lack of Medical Necessity, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

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)

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Provider Fraud,

January 15, 2016

Oceanside, California-based hospital Tri-City Medical Center agreed to pay $3,278,464 to resolve allegations it violated the Stark Law and False Claims Act by maintaining improper financial arrangements with community-based physicians and physician groups. According to the government, Tri-City maintained 97 improper financial arrangements with physicians and physician groups, including with its former chief of staff. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Hospital Fraud,

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