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December 15, 2022

Florida-based Ocenture LLC and its subsidiary, Carelumina LLC, have agreed to pay $3 million to settle allegations of submitting claims to Medicare that were tainted by illegal kickbacks.  Two marketers approached by Ocenture to participate in the kickback scheme, Christopher Improta and Peter Brandt, filed a qui tam suit against Ocenture which alleged the company provided kickbacks to physicians to have them falsely attest that genetic tests Ocenture solicited directly from Medicare beneficiaries was medically necessary.  The whistleblowers also alleged that Ocenture arranged for laboratories to process those tests and pay it a portion of the laboratories’ Medicare reimbursements.  For instigating a successful enforcement action, Improta and Brandt will share a $570,000 award.  DOJ

November 14, 2022

The Florida Birth-Related Neurological Injury Compensation Association and a related entity, which were created by the State of Florida to provide compensation for the medical, rehabilitative and custodial care of children who suffered certain categories of birth-related neurological injuries, will pay $51 million to resolve a whistleblower’s qui tam lawsuit, pursued on a non-intervened basis, alleging that they fraudulently caused NICA participants to submit their healthcare claims to Medicaid rather than NICA, in violation of Medicaid’s status as the payer of last resort under federal law.  The relators, Veronica Arven and the estate of Theodore Arven III, will receive $12,750,000 as their share of the recovery.  DOJ

October 31, 2022

Felix Amos of Houston, TX will serve 30 months in federal prison and will pay over $21 million in restitution for his role in a Medicare fraud scheme carried out with two other co-defendants. From 2010 to 2015, Amos owned and operated home health companies Dayton Health Bridges, Access Practical Solutions, Advanced Holistic, GetUpandWalk Inc., and Guaranty Home Health Agency. Amos and his co-conspirators submitted false claims to Medicare for patients that did not need or receive services, including deceased or incarcerated persons, and for services not ordered by a physician. USAO SDTX

October 14, 2022

The owners of two Texas-based home health clinics have been sentenced to 10 years in prison each after a jury convicted them of conspiring to commit healthcare fraud.  Alfred Olotin Alatan, who owned Colony Home Health Services, and Francis Ekene, who owned Milten Medical Clinic, allegedly paid recruiters for patient information, then billed providers for home health services, regardless of need.  Co-conspirators Susana Bermudez and Rita Kpotie Smith, both of whom operated the clinics under Alatan’s direction, are currently serving 2.5 years and 5 years in prison, respectively.  USAO SDTX

September 27, 2022

Following a whistleblower complaint that alleged Massachusetts-based Public Consulting Group LLC (PCG) overbilled Medicaid, in violation of the False Claims Act, the company has agreed to pay $2.5 million.  According to whistleblower Shane Shackford, PCG caused local school districts to submit false claims to Medicaid while under contract with the State of New Jersey to administer its Special Education Medicaid Initiative (SEMI) program—which provides federal funding to the state and local school districts for providing certain medical services to eligible students.  For his role in the case, Shackford will received a 21% share of the settlement.  USAO NJ

September 14, 2022

New York-Presbyterian/Queens Hospital has agreed to pay over $2.5 million to settle allegations that a former physician repeatedly performed and billed federal healthcare programs for medically unnecessary procedures, at the risk of patient health.  The procedures involved replacing batteries in an implanted pacemaker type device, even though batteries were still functioning normally and did not yet need to be replaced.  USAO EDNY

August 18, 2022

The organized healthcare system for Ventura County, as well as three healthcare providers, have agreed to pay a combined total of $70.7 million to resolve allegations of violating the California and federal False Claims Acts in connection with Medi-Cal’s Adult Expansion program, which extended coverage to previously uninsured adults without dependents.  Gold Coast Health Plan, Dignity Health, Clinicas del Camino Real, Inc., and Ventura County (the owner and operator of Ventura County Medical Center) allegedly submitted, or caused to be submitted, bills for unallowed expenses, bills for “Additional Services” that were duplicative of services already required, and bills with pre-determined costs that weren’t reflective of fair market value.  CA AG; USAO CDCA

August 11, 2022

Spivack, Inc., formerly operating as Verree Pharmacy, and owner-pharmacist Mitchell Spivack, have agreed to pay over $4.1 million in civil penalties for dispensing opioids despite numerous red flags the drugs were being diverted—all in violation of the False Claims Act and the Controlled Substances Act. In furtherance of the fraud, Spivack made false statements to drug distributors to maintain the façade of legitimacy, while concurrently drawing millions from the pharmacy and harming the public. In addition to their opioid fraud, Spivack and Verree effectuated their “Bill But Don’t Fill” scheme, where they would enter “BBDF” in their internal computer system, and would submit false claims to insurers for drugs not actually dispensed. USAO EDPA

August 5, 2022

Gonzaga Interventional Pain Management, Melvin Gonzaga, M.D., and his son Rommel Gonzaga will pay $980,000 for violating the False Claims Act by submitting claims for medically unnecessary urine drug tests. GIPM required patients to submit a UDT sample before being seen by a provider and discussing the results from any prior UDT the patient received. Regardless of the patients’ individualized testing needs, GIPM always opted for the more complex “definitive” UDT rather than the lower-level “presumptive” UDT, netting a higher reimbursement rate from the US government. USAO MD

August 4, 2022

Eastern Iowa Dermatology, PLC and Dr. Manish Kumar will pay $1.66 million for violating the False Claims Act. Defendants submitted up-coded claims to Medicare for office visits and destruction or removal of skin tags and lesions, the sole purpose of which is to increase Medicare’s reimbursement rate. In addition to the monetary penalty, they agreed to an Integrity Agreement and are subject to ongoing monitoring by the US DHHS. USAO SDIA
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