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Catch of the Week — Hospice Provider to Pay $6 Million to Settle False Claims Act Suit

Posted  12/21/18
Younger person resting hand on hand of seated elderly woman with cane
SouthernCare, Inc., a hospice provider owned by Curo Health Services, has agreed to pay the federal government nearly $6 million dollars to settle a lawsuit alleging that the company defrauded Medicare by billing medically unnecessary hospice care. The fraud was unearthed by two whistleblowers formerly employed by the company, who filed suit under the qui tam provisions of the False Claims Act, where they will share...

10th Circuit Finds that Doctor’s Judgment is Not Automatically Reasonable and Necessary

Posted  07/20/18
By Poppy Alexander Top-level heart surgeons work in a rarified world, where few may question their medical judgment. Yet that judgment is not infallible-and its presence is not in itself a protection against False Claims Act liability. The Tenth Circuit recently held as much in United States ex rel. Polukoff v. St. Mark’s Hospital et al., finding that a doctor may be exercising medical judgment while still...

Catch of the Week -- Healogics

Posted  06/22/18
This week's Department of Justice "Catch of the Week" goes to Healogics, Inc. On Wednesday, the Florida-based operator of hundreds of wound care centers agreed to pay up to $22.5 million to settle claims it violated the False Claims Act by billing Medicare for medically unnecessary and unreasonable hyperbaric oxygen therapy. See DOJ Press Release. Hyperbaric therapy involves breathing oxygen inside a pressurized...

Catch of the Week -- Signature HealthCARE

Posted  06/15/18
In a major victory for patients and taxpayers alike, DOJ announced an over $30 million settlement with Signature HealthCARE, LLC, a Kentucky-based company accused of overbilling federal healthcare programs for rehabilitation and skilled-nursing services. As a prime example of how valuing profits over patients can lead to fraudulent behavior, Signature HealthCARE wins the title of Catch of the Week. The settlement...

US Obtains $114M FCA Judgement in Kickbacks Case

Posted  05/31/18
On May 23, the US District Court in South Carolina issued judgment for the US for roughly $114M against three individuals, LaTonya Mallory, Floyd Dent III, and Robert Johnson, for violating the FCA by paying kickbacks to doctors in exchange for patient referrals. The defendants also caused two labs to bill Medicare, TRICARE, and Medicaid for medically unnecessary tests. The judgment follows a January jury verdict that...

Medicare Fraudsters Beware; DOJ May Be Reviewing Your Billing Data

Posted  05/15/18
By the C|C Whistleblower Lawyer Team Maryland physician Sureshkumar Muttath agreed to pay more than $1.5 million to settle claims he violated the False Claims Act by submitting claims to Medicare for medically unnecessary autonomic nervous function tests and neurobehavioral status exams.  The settlement originated under DOJ’s new initiative of tracking irregularities in Medicare billing data.  See DOJ Press...

Banner Health Agrees to Pay $18 Million to Settle Whistleblower Case

Posted  04/13/18
By the C|C Whistleblower Lawyer Team Banner Health has agreed to pay over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis.  Headquartered in Arizona, Banner Health owns and operates 28 acute-care hospitals in multiple states. “Taxpayers should not bear...

Fraudster of the Week -- Pharmacy Fraudster Steven Butcher

Posted  02/16/18
By the C|C Whistleblower Lawyer Team On Wednesday, former pharmaceutical sales representative Steven Butcher admitted to running a $45 million scheme to swindle both federally-funded and private health care benefit programs.  Butcher was charged with one count of conspiracy to commit health care fraud and one count of conspiracy to violate the Anti-Kickback Statute, a law designed to remove financial incentives...

Fraudster of the Week -- Former Football Player Monty Grow

Posted  02/9/18
By the C|C Whistleblower Lawyer Team On Monday, a federal jury in Miami unanimously convicted Monty Grow of running a compound pharmaceutical drug conspiracy that bilked $20 million from TRICARE, a healthcare program for military members and their families. Grow was a star linebacker at the University of Florida in the early 1990s and spent two seasons as a cornerback in the NFL. Prosecutors accused Grow of...

South Carolina Resident Found Liable for $51 Million in Health Care Fraud

Posted  02/2/18
By the C|C Whistleblower Lawyer Team The United States Attorney’s Office in South Carolina announced that a federal jury returned a unanimous verdict against Floyd Calhoun “Cal” Dent and two co-conspirators, Robert Bradford Johnson and LaTonya Mallory, for defrauding Medicare and Tricare. The government alleged that Mr. Dent and his co-conspirators paid kickbacks to physicians so they would order medically...