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May 6, 2019

Acadia Healthcare Company, Inc., which operates outpatient drug treatment centers in West Virginia through its subsidiary CRC Health, L.L.C., will pay $17 million to resolve claims that it improperly billed the state's Medicaid program for urine and blood testing services as if they had performed the testing themselves, despite the fact that Acadia lacked the certification to perform the tests.  In fact, the testing was performed by an independent outside laboratory, and that lab independently billed Medicaid for the tests, at a lower rate. Medicaid paid Acadia’s treatment centers $8,500,000 for the improperly-billed tests.  As part of this settlement, defendants also entered into a five-year corporate integrity agreement to maintain specified compliance programs and procedures.  USAO SDWV

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud,

May 3, 2019

Dr. Richard E. Paulus, an Ashland cardiologist, was sentenced to five years in prison for defrauding Medicare, Medicaid, and private insurers. Evidence showed that Paulus implanted medically unnecessary stents in his patients and falsified the degree of stenosis in their medical records. He has been charged with one count of health care fraud and ten counts of making false statements in regard to health care matters. In addition to time in prison, Paulus must also pay $1.1 million in restitution to Medicare, Medicaid, and other private insurers who were also victims of his financial scheme. DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare,

May 2, 2019

Chimes Delaware, which provides services to individuals with developmental disabilities in Delaware, will return $4.5 million in Medicaid funding to the state to resolve claims of billing errors in its supported employment programs and transportation services.  Chimes also agreed to institute new internal controls and billing procedures.  DE

Tagged in: Ambulance, Medicaid, Medical Billing Fraud, Provider Fraud,

May 2, 2019

Insys Therapeutics executives were convicted for their part in a racketeering conspiracy where they defrauded Medicare and private insurance carriers. From May 2012 to December 2015, the defendants bribed medical practitioners to prescribe Subsys, an extremely addictive sublingual fentayl spray intended for use by cancer patients. In furtherance of these efforts, the defendants provided kickbacks to practitioners who increased their Subsys prescriptions. The defendants also defrauded health insurance providers who were hesitant to approve payment for the drug when it was prescribed for non-cancer patients. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medicare, Off-Label and Unapproved Use, Pharma Fraud,

April 30, 2019

Anna Ramira-Ambriz, the owner of a durable medical equipment (DME) company, pleaded guilty on March 31, 2017, to defrauding Medicare out of more than $3 million. Ramirez-Ambriz owned Compassionate Medical Supplylocated in Edinburg.  From 2007 through 2013, Ramirez-Ambriz billed Texas Medicaid for higher quantities and more costly incontinence supplies than were actually delivered. She will be sentenced to federal prison for over six years, followed by an immediate three years of supervised release. Ramira-Ambriz was also ordered to pay over $3 million in restitution to the Texas Medicaid Program. DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Devices and DME,

April 30, 2019

Home healthcare company Avenue Homecare Services, Inc, of Dracut, Massachusetts, will pay $8.3 million to resolve allegations that between 2013 and 2016 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Avenue submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 30, 2019

Home healthcare company Amigos Homecare, LLC, of Lawrence, Massachusetts, will pay $2.13 million to resolve allegations that between 2014 and 2018 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Amigos submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 18, 2019

Two former business partners behind three hospice and home healthcare agencies in the Las Vegas area have been sentenced for their roles in a $7.1 million Medicare fraud scheme.  Camilo Primero and Aurora Beltran—the owners of Advent Hospice, Angel Eye Hospice, and Vision Home Health Care—had been previously convicted of defrauding California’s insurance system in connection with another business, the Beltran House for disabled adults, and Primero had been excluded from participating in federal healthcare programs.  To get around the exclusion, the two filed false enrollment forms to Medicare, then submitted false claims for unqualified beneficiaries.  Each has been sentenced to three years of supervised release and ordered to pay $2,492,627.  USAO NV

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

April 15, 2019

Cardiac Associates, P.C. will pay the United States over $399,000 to settle False Claims Act allegations related to improper billing practices. The U.S. contends that between January 1, 2012, and December 21, 2016, Cardiac Associates double billed for procedures on the same date for the one patient, when only one of the procedures was performed. Cardiac Associates also allegedly billed for two tests when testing patients for venous sufficiency, even though Medicare rules prohibit billing for both CPT 93970, the newer test, and CPT 93965, an older test using different technology. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare,

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