Archive

March 8, 2022

Eugene Sisco, III of Kentucky, the owner and operator of several medication assisted treatment (MAT) clinics for opioid addiction, has been sentenced to over 10 years in prison and ordered to pay $5.7 million in restitution, after being convicted of healthcare fraud. Sisco was found to have tricked Medicaid patients into paying hundreds of dollars in cash each month for MAT services which he later billed and was reimbursed by Medicaid for. Sisco’s laboratory, Toxperts, LLC, was also found to have billed Medicare for medically unnecessary urine drug tests, causing a loss of over $2 million to CMS. USAO EDKY

Tagged in: Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid,

March 7, 2022

Redwood Toxicology Laboratory has agreed to pay nearly $4.8 million to settle allegations that the California-based urine drug testing service overcharged the Connecticut Medicaid program for certain laboratory services, in violation of Connecticut’s “Most Favored Nation” regulation, which provides that the state should not be charged more than the lowest price charged to third parties. The settlement covered claims submitted between January 2015 through February 2018. USAO CT

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

February 10, 2022

Bradley Jason Kantor, 49, will spend 10 years in federal prison after being found guilty of paying kickbacks for referrals to his immunotherapy and antigen business, Mobile Diagnostic Imaging, Inc. (MDI). MDI received more than $12 million from the scheme in which MDI submitted approximately $42 million in false claims to United Healthcare, for which services were never rendered. USAO SDFL

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Laboratory and IDTF,

January 20, 2022

A three-year-long kickback scheme effectuated by a hospital executive and seven doctors will net the DOJ a $1.1 million settlement and their continued cooperation in the investigation of and litigation against other parties. The Stark Law and Anti-Kickback Statute violations occurred over a three-year period, wherein management service organizations (MSOs) paid volume-based commissions kickbacks for ordering laboratory tests from Rockdale Hospital d/b/a Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation. Jaspaul Bhangoo, M.D., Robert Megna, D.O., Baxter Montgomery, M.D., Murtaza Mussaji, D.O., David Sneed, D.O., Kevin Lewis, D.O., and Angela Mosley-Nunnery, M.D. will all contribute to the settlement. Additionally, Richard Defoore, former CEO of Jones County Regional Healthcare d/b/a Stamford Memorial Hospital, also agreed to pay into the settlement fund for his contribution to the scheme. USAO EDTX

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Hospital Fraud, Laboratory and IDTF, Provider Fraud,

November 22, 2021

South Carolina chiropractor Daniel McCollum has consented to judgment of $9 million to resolve charges that he submitted false claims to federal healthcare programs in violation of the Anti-Kickback Statute and Stark Law. McCollum admitted that his laboratory, Labsource (which was a party to a related action), gave referring providers an opportunity to earn revenue generated from their commercially-insured referrals for urine drug testing as an inducement for those providers to refer all of their federally-insured urine drug testing patients to Labsource. McCollum also caused medically unnecessary prescriptions for pain creams often without the knowledge or approval of the patients’ healthcare providers. In addition to the civil settlement, McCollum pleaded guilty to criminal kickback and healthcare fraud charges and will be sentenced at a later date. DOJ; USAO SC

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Provider Fraud,

October 22, 2021

Texas doctors Robert Wills and Brannon Frank, who previously operated Austin Pain Associates, will pay $3.9 million to resolve allegations that they billed federal and state healthcare programs for medically unnecessary urine drug tests that were performed at Austin Pain Associates’ in-house lab. The investigation was initiated after a whistleblower complaint was filed by former Austin Pain Associates employees Jennifer Nuessner and Robert Hoffman; they will receive approximately $618,000 from the federal share of the settlements. DOJ

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

October 8, 2021

U.S. Medical Management, LLC (USMM) and VPA, P.C. (VPA) have agreed to pay $8.5 million to resolve claims raised in five separate qui tam lawsuits that USMM and VPA billed Medicare for medically unnecessary laboratory and diagnostic testing services between 2010 and 2015. Although the government did not join any of the lawsuits, the whistleblower who filed first will receive $1.53 million under the alternate remedy provision of the False Claims Act. USAO EDMI

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Multiple Whistleblowers and First-to-File, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 19, 2021

Nevada Advanced Pain Specialists agreed to pay $1 million to resolve allegations that it submitted false claims for confirmatory urine drug testing performed without regard to the results of presumptive tests that had been performed. The allegations were first brought in a qui tam lawsuit filed by an whistleblower Omni Healthcare, Inc., which will receive a relator’s share of $150,000 of the settlement. USAO MA

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

July 22, 2021

Medical laboratory Bluewater Toxicology, LLC, agreed to pay $1.2 million following its self-report of overbilling for urine drug testing services. In billing Medicare, Kentucky Medicaid, Indiana Medicaid, TRICARE, and CHAMPVA, Bluewater was alleged to have submitted false claims that misrepresented the number of drugs tested in definitive urine drug tests, that lacked sufficient documentation, or that were for specimen validity testing that is not separately billable to Medicare. USAO ED KY

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

July 9, 2021

Genetworx Laboratories, a diagnostic laboratory in Virginia, has agreed to pay $1.4 million to resolve allegations of submitting false claims to Medicare in violation of the False Claims Act. Over the course of a year, Genetworx allegedly billed for genetic tests that were performed on groups of senior citizens in senior homes without valid physician oversight. USAO NJ

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

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