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March 4, 2020

STG Healthcare of Atlanta, Inc. and senior executives Paschal Gilley and Mathew Gilley have agreed to resolve fraud allegations by paying $1.75 million.  The case against the hospice was launched by two former employees, Serita Samuel and Miranda Eskridge, who alleged in a qui tam suit that STG Healthcare submitted false claims to Medicare and Medicaid that arose from illegal payments to so-called back-up medical directors, and that were on behalf of patients who were not terminally ill and thus ineligible for palliative care.  GA AG; USAO NDGA

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

February 19, 2020

Guardian Elder Care Holdings, Inc. has agreed to pay $15.5 million to settle claims of defrauding Medicare and Medicaid.  In a qui tam suit filed in 2015, whistleblowers Philippa Krauss and Julie White alleged that from 2011 to 2017, the Pennsylvania-based nursing home chain pressured its therapists to provide medically unnecessary rehabilitation to patients suffering from dementia or dying in hospice care in order to boost its profits.  During the subsequent government investigation, Guardian Elder Care self-disclosed that it had also billed federal healthcare programs for services performed by two excluded individuals.  As part of the settlement, Guardian Elder Care has entered into a chain-wide Corporate Integrity Agreement with the Department of Health and Human Services, and Krauss and White will split a $2.8 million relator's share.  USAO EDPA; USAO WDPA

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

February 6, 2020

A patient recruiter in Kentucky has been sentenced to 5 years in prison and ordered to pay or forfeit over $1.2 million in total for accepting more than $1 million in kickbacks from home health agencies in exchange for providing information about Medicare beneficiaries.  The owner of Trumbo Consulting Agency in Virginia, Dominic Trumbo recruited and paid others to recruit over 4,000 Medicare beneficiaries for home health services by offering incentives to get them to sign up.  Trumbo then sold the information to home health agencies around the country in exchange for kickbacks, then created fake contracts and invoices to conceal the fraud from Medicare.  DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

December 20, 2019

Florida residents and married couple Rodolfo Pichardo and Marta Pichardo were sentenced to 15 years and 8 years, respectively, following earlier guilty pleas to healthcare fraud and wire fraud.  Defendants were also ordered to pay over $34 million in restitution. The Pichardos ran a network of home health agencies, pharmacies, and therapy staffing companies, that submitted more than $38 million in false claims to Medicare.  Defendants paid kickbacks to patient recruiters and medical clinics for patient referrals.  USAO SD FL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medical Billing Fraud, Pharma Fraud,

December 17, 2019

Miracle Home Care, Inc. and its owner, Shashicka Tyre-Hill, have together been ordered to pay more than $10 million following judgment in an action under the False Claims Act finding that defendants defrauded Georgia’s Medicaid program.  In a civil complaint filed in July 2018, the federal government and State of Georgia alleged that Miracle Home Care submitted thousands of fraudulent reimbursement claims for medically unnecessary transportation and health services.  USAO SDGA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

November 13, 2019

The Louisiana Department of Health, which manages Louisiana’s Medicaid program, will pay $13.42 million to the federal government to resolve allegations that the state submitted false claims for federal share reimbursement of state Medicaid expenditures for long-term nursing care and hospice care.  The federal government alleged that in anticipation of a reduction in federal payments for such services, the state agency directed its healthcare contractor, Molina Medical Solutions, to pre-bill for nursing home and hospice services in order to receive funds at the existing higher rates.   DOJ

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

November 5, 2019

A home health agency that allegedly defrauded Medicare and Louisiana’s Medicaid program has agreed to pay $2.5 million to settle claims arising from a qui tam suit.  Defendants Health Care Options, Inc., Health Care Options of Lafayette, Inc., Home Care Options Houston, Inc., and Howard Austin, II allegedly submitted reimbursement claims involving non-face-to-face encounters, as required by program rules.  USAO MDLA

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Whistleblower Case,

October 28, 2019

Atheir Amarrah, the owner of Michigan-based Prompt Care Home Health Services Inc, has been sentenced to 5 years in prison and ordered to pay $1 million in restitution after pleading guilty to paying recruiters for referrals to Medicare beneficiaries.  In his guilty plea, Amarrah also admitted to billing Medicare for claims tainted by illegal kickbacks.  DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

October 17, 2019

Five home health providers in Iowa and South Dakota have been ordered to pay a combined $3.1 million for submitting false claims to Medicare.  Affiliates of Minnesota-based Welcov Healthcare LLC allegedly billed Medicare for therapy services that were not provided by skilled employees or not medically necessary.  Sergeant Bluff Healthcare, LLC will pay over $1.2 million, Logan Healthcare, LLC and Elk Point Healthcare #1, LLC will each pay over $775,000, Red Oak Healthcare, LLC will pay over $228,000, and Flandreau Healthcare 2, LLC will pay about $116,000.  USAO NDIA

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

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