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February 6, 2019

Families United Services, Inc. (FUS) and owner Pamela McKenzie have agreed to pay $645,000 to settle allegations of defrauding Georgia's Medicaid program from 2010 to 2012 by submitting claims for unprovided mental health services. As part of the settlement, FUS has been excluded from participating in federal healthcare programs for a period of five years. USAO NDGA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud,

February 6, 2019

Abbott Labs has agreed to pay a total of $25 million to settle allegations of paying kickbacks to healthcare professionals in exchange for promotion of its drug, and inappropriately marketing its drug, TriCor, for cardiovascular events not approved by the FDA. The case was initiated by the State of North Carolina and joined by California, Illinois, Nevada, Maryland, Michigan, and Texas, as well as the federal government. NC AG

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicaid, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud,

February 6, 2019

Georgia-based Union General Hospital has agreed to pay $5 million to settle allegations that from 2012 to 2016, it billed Medicare for services stemming from improper financial relationships with physicians, in violation of the Stark Law and the False Claims Act. The misconduct was uncovered during an internal investigation sparked by a federal investigation into an unrelated matter; UGH then voluntarily self-disclosed details of the instant case to the U.S. Attorney's Office. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicare,

February 5, 2019

Tennessee Health Management, Inc (THM) has agreed to pay over $9.7 million to settle fraud allegations, with over $5 million going to the United States and over $4 million going to the State of Tennessee. From 2010 to 2017, the skilled nursing facility management company allegedly submitted claims with false physician certifications to the state's Medicaid Program, TennCare, in violation of TennCare's rules as well as the False Claims Act. As part of the settlement, THM has also agreed to sign a Corporate Integrity Agreement. USAO MDTN

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Medicaid, SNF,

February 5, 2019

Two doctors from the Florida-based Fishman & Sheridan Eye Care Specialists clinic have agreed to pay a combined $157,312.32 to settle their liability under the False Claims Act. Drs. Craig D. Fishman and Jeffrey A. Sheridan were outed in a qui tam complaint filed by former business partner Dr. Michael Pennachio and office manager Sharon Drake, which alleged that from 2011 to 2017, Fishman and Sheridan knowingly billed Medicare for blepharoplasty and ptosis repair surgeries that were purportedly performed on the same patients, even though they are mutually exclusive eyelid repair surgeries. For exposing the fraud, Pennachio and Drake will receive a relator's share of $26,000. USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

February 1, 2019

Ali Jama, co-owner of Alpha Star Health Care Inc., was sentenced to 18 months in prison for health care fraud and tax fraud schemes against Medicare and Medicaid. Jama billed the government for services performed by unqualified individuals with criminal backgrounds who were prohibited from providing direct care. Jama also billed for services provided by untrained home health aides and provided false documents and false records for his taxes to reduce his company’s tax liability from approximately $680,000 to $81,000. Jama has been ordered to forfeit $300,000 and pay $392,000 in restitution to Medicaid. He must also pay the IRS $311,000 in restitution. DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medicare, Tax Fraud,

January 29, 2019

Two doctors and a health clinic owner in the Houston area have each been sentenced to decades in prison following their convictions for Medicare fraud. In one case involving three defendants—clinic owner Ann Shepherd, doctor John Ramirez, and Yvette Nwoko—Medicare paid over $17 million in fraudulent claims resulting from false certifications related to services not medically necessary or properly provided. Defendants Shepherd was sentenced to 30 years in prison, and ordered to pay $20 million; Ramirez was sentenced to 25 years in priosn and ordered to pay $26 million; Nwoko awaits sentencing. In a second case, related case, doctor Anh Do was sentenced to three years in prison and ordered to pay almost $2 million in restitution on similar charges. DOJ 1; DOJ 2

Tagged in: Certifications, Criminal Proceedings, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicare,

January 29, 2019

Tennessee-based home dialysis provider WellBound of Memphis agreed to pay $3,246,000 to the State of Tennessee and the United States for allegedly submitting false claims to Medicare, TRICARE, and Tenncare from 2016 to 2018. According to a qui tam complaint filed by whistleblower Dr. Darryl Quarles, the claims resulted from illegal inducements for patient referrals, which violated the anti-kickback statute (AKS) and are not payable under state or federal laws. USAO WDTN

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medicare, Other Government Health Programs, Whistleblower Case,

January 28, 2019

Avanti Hospitals LLC and six of its owners will pay $8.1 million to settle claims that they violated the False Claims Act by submitting, or causing Avanti’s subsidiary, Memorial Hospital of Gardena, to submit false claims to the Medicare and Medicaid programs for medical services referred by a physician who received kickbacks and other improper payments from Gardena and other Avanti affiliates. The settlement partially resolves allegations originally brought in a whistleblower lawsuit filed by Dr. Joshua Luke, the former C.E.O. of Gardena Hospital. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Whistleblower Case,

January 28, 2019

Ademola O. Adebayo, of Odessa, FL, was convicted for his role in a massive compounding pharmacy fraud scheme through which he submitted false and fraudulent claims for compounded drugs and other prescription medications that were not medically necessary, never provided, or both. The evidence established that in his role as the pharmacist at A to Z Pharmacy, now-defunct, Adebayo conspired to submit or cause the submission of claims that often amounted to several thousands of dollars for a single tube of pain or scar cream. When the fraud was uncovered, Adebayo became the straw owner of Havana Pharmacy & Discount in Miami, where Adebayo and his co-conspirators continued the fraud. Adebayo personally benefited from the fraud and received $1.5 million. DOJ

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs,

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