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May 26, 2021

Nurse practitioner Trivikram Reddy was sentenced to 20 years in prison following his guilty plea on healthcare conspiracy and wire fraud charges.  Reddy stole the identities of six physicians to submit fraudulent bills to Medicare and private insurers including Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana, and Cigna. When federal agents began their investigation, Reddy took steps to manufacture medical records to support his fraudulently-submitted bills, and diverted millions of dollars in proceeds of the fraud to himself.  In addition to the prison sentence, Reddy was ordered to pay more than $52 million in restitution.  USAO ND TX

May 26, 2021

A licensed insurance broker, Tarek Abou-Katwa, was sentenced to 70 months in prison for his role in a scheme to defraud CareFirst BlueCross BlueShield of more than $3.8 million.  According to evidence presented at trial, Mr. Abou-Katwa created fictitious employees and altered years of birth of actual employees to lower the average age of insured groups and fraudulently obtain lower insurance premiums.  He then inflated the rates charged to clients and pocketed the difference, which was in excess of $3.6 million.  When audited, he created false sense reports and other documents.  Mr. Abou-Katwa will also pay $3.8 million in restitution and forfeit $8.4 millionDOJ

May 26, 2021

HEAG Pain Management Center, P.A. (HEAG) and its owner, Dr. Kwadwo Gyarteng-Dakwa (Dr. Dakwa), have agreed to pay $500,000 to settle allegations of defrauding Medicare and Medicaid.  According to the government, the defendants knowingly submitted or caused the submission of claims for medically unnecessary diagnostic testing between 2011 and 2016.  AG NC; USAO MDNC

May 21, 2021

SavaSeniorCare LLC and related entities (“Sava”) will pay $11.2 million, plus potentially more pursuant to an “ability-to-pay” settlement, to resolve allegations that Sava violated the False Claims Act by causing its skilled nursing facilities to bill Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled, and that Sava billed the Medicare and Medicaid programs for grossly substandard (i.e., “worthless”) skilled nursing services.  The settlement stems from four separate qui tam complaints filed by whistleblowers Rita Hayward, Trammel Kukoyi, Terrence Scott, James Thornton, and Barbara Roberts, who will share an undisclosed portion of the government’s recovery.  In 2015, the United States intervened in the litigation and filed a consolidated False Claims Act complaint, alleging inter alia that Sava had exerted significant pressure on its skilled nursing facilities to meet unrealistic corporate targets for the highest Medicare reimbursement rates without regard to patients’ actual clinical needs, and improperly delayed the discharge of patients from its facilities in order to increase billings.  Sava will enter into a five-year Corporate Integrity Agreement as part of the settlement.  DOJ

May 18, 2021

Javaid Perwaiz, an ob/gyn who practiced in Hampton Roads, Virginia, was sentenced to 59 years in prison after a jury convicted him of charges related to his performance of hysterectomies, sterilizations, and other medically unnecessary surgeries and procedures on patients without their informed consent - in many cases by falsely telling them they had cancer or needed the procedure to avoid cancer.  In addition, Perwaiz induced labor in patients early so that he could bill for the deliveries, sometimes falsifying records to support the induction.  USAO ED VA

May 14, 2021

Texas dentists Gunjan Dhir and Gaurav Puri and their affiliated management companies and practice groups will pay $3.1 million to resolve allegations that they fraudulently charged the Texas Medicaid program for pediatric dental services.  The investigation was initiated by the filing of a qui tam complaint by whistleblowers Sandy Puga, Nelda Torres-Brown, and Sonia Cardoso, who were former employees of defendants and will receive an undisclosed share the settlement.  Defendants allegedly billed for services that were not actually provided and/or misreported the provider of services by using erroneous Medicaid provider numbers.  USAO ND Texas

May 10, 2021

The University of Miami, which operates multiple hospitals and other healthcare facilities, will pay $22 million to resolve claims arising from allegedly fraudulent billing submitted to federal healthcare programs for laboratory services.  The university was alleged to have billed certain laboratory tests as having been provided at hospital facilities instead of at physician offices, without satisfying the requirements for that more costly hospital facility billing, including notice requirements.  In addition, the university was alleged to have performed and billed for a pre-set panel of tests for all kidney transplant patients, although not all included tests were medically necessary.  Finally, the university and Jackson Memorial Hospital, which jointly operated the kidney transplant program, were alleged to have violated related party restrictions by billing for pre-transplant laboratory tests ordered by JMH from the university, and JMH will pay an additional $1.1 million to settle these allegations.  The settlement resolves claims made in three separate qui tam lawsuits; the whistleblower's share has not yet been determined.  DOJ; USAO SD FL

May 5, 2021

Neurosurgical Associates, LTD and Dignity Health, d/b/a St. Joseph’s Hospital, have agreed to a $10 million settlement and five-year corporate integrity agreement to resolve allegations of violating the federal False Claims Act.  According to whistleblower Dr. Bruce P. Kingsley, Neurological Associates and St. Joseph’s Hospital improperly billed Medicare for certain doubly and triply concurrent and overlapping surgeries.  USAO AZ

May 4, 2021

After being convicted of running a $11 million healthcare fraud scheme, Brenda Rodriguez, the owner and operator of Texas-based QC Medical Clinic, has been ordered to spend 25 years in prison, followed by 3 years of supervised release.  As shown by evidence presented at trial, Rodriguez’s scheme involved paying doctors to approve Medicare beneficiaries for home health services, selling the approvals to various home health providers, and causing the providers to bill Medicare for services that were medically unnecessary, never provided, and/or arose from illegal inducements.  USAO SDTX

April 29, 2021

Over two dozen defendants who were part of an extensive prescription drug fraud scheme involving Alabama-based Northside Pharmacy d/b/a Global Compounding Pharmacy have been sentenced to prison.  The defendants included company executives and managers, prescribers, billers, and sales representatives who, between 2013 and 2016, billed insurers such as Medicare and TRICARE for massive quantities of medically unnecessary prescription drugs.  In just that short period of time, the defendants caused insurers to pay nearly $50 million in medically unnecessary claims, with more than $13 million arising from improper payments to prescribers, and more than $8.4 million for prescriptions written out to Global employees themselves.  USAO NDAL
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