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April 4, 2019

Jazz Pharmaceuticals will pay $57 million to settle allegations that the company violated the False Claims Act by providing funds to a purportedly independent patient assistance program in a form that created an improper kickback.  The funds provided by Jazz were used to cover the copayments for patients to purchase Jazz's drugs Xyrem, a narcolepsy medication, and Prialt, an injectable pain medication.  Jazz referred Medicare patients to the fund, and denied them access to Jazz's free drug program, enabling Jazz to bill Medicare for their purchases. DOJ  

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Medicare, Pharma Fraud,

April 4, 2019

Oral and Maxillofacial Surgical Associates P.C. of New Haven, Connecticut, and its former owner Robert Sorrentino DDS, have agreed to pay $252,000 to settle claims that they submitted false claims to Medicaid by billing for services that were not provided, were not medically necessary, or were covered under other claims submitted for the same date of service.  The fraudulently-billed services included deep sedation or general anesthesia and removal of bone or tissue.  USAO CT

Tagged in: Bundling and Unbundling, FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

April 2, 2019

Paul Emordi, of Collin County, Texas, was sentenced to prison for 60 months for his part in a $3.7 million health care scheme involving Medicare. Emordi and Celestine “Tony” Okwilagwe, owners and operators of Elder Care, along with Adetutu Etti, the administrator of Elder Care, were convicted on counts of conspiracy to commit health care fraud and on counts of false statements in connection with a health care benefit program. Evidence in the investigation also shows that the defendants submitted fake and fraudulent bills to Medicare for providing services that were not necessary. DOJ; Texas

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicare,

March 29, 2019

CareWell Urgent Care of Rhode Island, P.C., and Urgent Care Centers of New England Inc. have agreed to pay $2 million to settle a qui tam suit brought on by a former employee, Aileen Cartier. In violation of the False Claims Act, CareWell had falsely inflated the level of services provided and failed to identify service providers in claims submitted to Medicare, Massachusetts and Rhode Island Medicaid, and the Massachusetts Group Insurance Commission (GIC) between 2013 to 2018. For bringing on the suit, Cartier will receive a 17% relator's share. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

March 29, 2019

Acacia Mental Health Clinic and its owner, Abraham Freud, have agreed to pay $4.1 million to the United States and the State of Wisconsin for submitting false claims to Medicaid in violation of the False Claims Act. According to a qui tam complaint filed by whistleblower Rose Presser, Acacia billed for urine drug screens in simple "cup" tests as if a more sophisticated test had been performed. Acacia also billed for medically unnecessary and duplicative urine drug tests and telemedicine services performed by foreign-based psychiatrists in violation of Medicaid regulations. USAO EDWI

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 27, 2019

In the second largest resolution of a Medicaid fraud case based in Washington State, CareOne Dental Corporation and its owners will pay $1 million to settle allegations of violating Washington's Medicaid False Claims Act. According to the AG's office, CareOne and defendants Dr. Liem Do and Dr. Phuong-Oanh Tran defrauded Medicaid by using higher paying codes, masking ineligible services as eligible services, and billing for services the practice didn't even provide. Ultimately, the defendants racked up about $1 million over the course of four years. AG WA

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

March 26, 2019

Accurate Home Care, LLC, a Minnesota-based home health provider has agreed to pay $726,957.59 after voluntarily self-disclosing its violations of the False Claims Act in duplicated bills sent to both Medicaid and private insurers. Accurate had also admitted to fraudulently retaining payments from Medicaid even when Medicaid wasn't the primary insurer. USAO MN

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

March 26, 2019

The owner and managing member of a Mississippi-based pharmacy has plead guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering and tax evasion in connection with a massive $200 million compounding pharmacy scheme involving at least 12 individuals over four years. Glenn Doyle Beach, Jr. of Advantage Pharmacy admitted to marketing and formulating compounded medications for TRICARE patients without regard to medical necessity, falsifying paperwork to mislead auditors, and engaging in money laundering and tax evasion to conceal proceeds. He is scheduled to be sentenced in July. DOJ; USAO SDMS

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs, Tax Fraud,

March 21, 2019

Nonprofit healthcare organization MedStar Health Inc. has agreed to pay $35 million to the United States to settle two qui tam lawsuits alleging violations of the False Claims Act at two of its hospitals in Baltimore. According to the first complaint, filed by three cardiac surgeons, MedStar paid illegal remuneration to MidAtlantic Cardiovascular Associates (MACVA) to induce referrals of Medicare patients. The second complaint, filed by former patients, alleged that while employed by MedStar, former MACVA employee Dr. John Wang engaged in a pattern of performing and billing for medically unnecessary cardiac stent procedures. DOJ

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

March 19, 2019

Ademola O. Adebayo was sentenced to 10 years in prison for his role in a huge $100 million compounding pharmacy scheme that defrauded private insurance companies, Medicare and TRICARE. Adebayo was also ordered to pay $3.2 million in restitution and $1.4 million in forfeiture, and properties, cars and a yacht have been sequestered as part of the sentencing. After a four-day trial on January 11, Adebayo was convicted on counts of conspiracy to commit health care fraud and wire fraud, and conspiracy to commit money laundering. Eight other defendants have pleaded guilty in connection with the scheme. DOJ

Tagged in: Healthcare Fraud, Medicare, Pharma Fraud,

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