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January 28, 2019

Norma Zayas, of Miami, was sentenced to 51 months in prison for her role in a $4.66 million health care fraud scheme involving several Miami-area home health agencies, including Sunshine Home Health Services Inc., Empire Home Health Agency Inc., Mildred & Marce Home Health Care Services Inc., and Nursing Care PRN Inc., which purported to provide home health services to Medicare patients. Zayas must also pay $4,658,241.00 in restitution and forfeit $186,650.50. Zayas admitted that from approximately January 2010 through approximately January 2014, she operated Sunshine, Empire, and Mildred & Marce Home Health and paid kickbacks to patient recruiters in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services. She also paid kickbacks to patient recruiters who referred Medicare beneficiaries to Nursing Care PRN. As a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of nearly $4.66 million. DOJ

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

January 22, 2019

Walgreens Co. will pay the U.S. and the State of Wisconsin $3.5 million to settle a case under the False Claims Act alleging that the retail pharmacy routinely dispensed stimulant medications to Wisconsin Medicaid beneficiaries without first verifying that the prescribing physician ordered the medication for medically appropriate treatment, such as treatment for attention deficit disorder. The case was initiated by unidentified whistleblowers, who will receive a share of the settlement to be determined. USAO EDWI

Tagged in: FCA Federal, FCA State, Lack of Medical Necessity, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

January 22, 2019

Walgreens Boots Alliance, Inc. will pay $60 million to settle a False Claims Act case brought by a whistleblower alleging that the retail pharmacy chain knowingly overcharged Medicaid when it charged the healthcare program more than "usual and customary price" for medications that participants in Walgreens "Prescriptions Savings Club" received at a lower price.  Of the settlement, approximately $32 million will be paid to the U.S. and $28 million to the affected states.  Whistleblower Marc D. Baker will receive a share of the total settlement, to be determined at a later date.  USAO SDNY

Tagged in: Drug and DME Pricing, FCA State, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

January 15, 2019

New York has reached a $9 million settlement with Diamond Braces, a chain of dental offices, and its principal Oleg Drut, DDS, for false claims Diamond made to NY's Medicaid program for orthodontic procedures that were performed by personnel who were not certified to perform the work they did as required by NY state law.  NY

Tagged in: Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud,

January 11, 2019

 Teva Pharmaceuticals USA Inc. will pay $135 million to the state of Illinois to settle allegations that published fraudulently inflated Average Wholesale Prices (AWPs) for numerous prescription drugs.  Illinois's Medicaid program bases its drug reimbursements for Medicaid beneficiaries on AWPs, and the inflated AWPs caused Illinois to overpay. IL AG

Tagged in: Drug and DME Pricing, Medicaid, Pharma Fraud,

December 18, 2018

Following an earlier settlement of federal claims, Florida has announced that hospital chain Health Management Associates, LLC, will pay $5.5 million to Florida to resolve claims that two HMA hospitals, Charlotte Regional Medical Center and Peace River Medical Center, billed the Florida Medicaid program for services referred by physicians to whom HMA provided remuneration in return for patient referrals.  The unlawful remuneration took the form of free rent, office space, and staff services, as well as direct payments purportedly meant to cover overhead and administrative costs.  FL AG

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid,

December 17, 2018

Margarita Palomino, of Homestead, Florida, has been sentenced to over six years in prison for her part in a health care scheme which defrauded Medicare out of $4.65 million. The scheme involved three home health agencies that claimed to provide services to Medicare patients. Palomino, licensed as a physician in Cuba, but not in the United States, admitted that she provided home health care nursing visits and prepared the accompanying medical records as would a licensed medical professional in the U.S. Furthermore, between the approximate time of January 2010 and January 2014, Palomino admitted to accepting kickbacks in return for the referral of Medicare beneficiaries, the majority of whom did not need or even qualify for the services. In addition to spending 78 months in prison, Palomino has been ordered to pay $4,658,241.00 in restitution and to forfeit $186,650.50.  DOJ        

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

December 14, 2018

Crossroads Hospice of Kansas has agreed to pay $300,000 for violating the Kansas False Claims Act. Under that law, once a healthcare provider is alerted to charges improperly submitted to the state's Medicaid program, it is obligated to refund the reimbursement in a timely manner or risk prosecution. In the case of Crossroads, the provider had failed to refund money paid on behalf of improperly certified beneficiaries. KS AG

Tagged in: FCA State, Home Health and Hospice, Lack of Medical Necessity, Medicaid,

December 14, 2018

Tamar Tatarian, owner of Akhtmar Pharmacy, was found guilty for her part in a scheme to defraud Medicare out of more than $1.3 million in false claims for prescription drugs. According to evidence presented during the two-day trial, Tatarian submitted false claims to Medicare Part D plan sponsors between October 2015 and October 2017 for prescription drugs that Akhtmar pharmacy had not actually ordered from wholesalers, and therefore were not dispensed to Medicare beneficiaries. Tartarian tried to cover up the fraud by generating fake invoices that included wholesale drug purchases by the pharmacy which had not, in reality, ever happened. Tatarian was convicted of one count of health care fraud and two counts of wire fraud. DOJ    

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

December 13, 2018

Hospice care provider SouthernCare, Inc. has agreed to pay $5,863,426 for submitting fraudulent claims to Medicare between 2009 to 2014. Under Medicare's eligibility rules, in order for hospice care to be reimbursed, a patient must have a life expectancy of six months or less as certified by a physician, and terminal illnesses must be documented with appropriate records. However, according to qui tam complaints by former employees Dawn Hamrock and Patricia Beegle, SouthernCare billed Medicare for care provided to patients who were not Medicare eligible or who had no proof of Medicare eligibility. As part of the settlement, Hamrock and Beegle will share a $1.1 million whistleblower reward. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

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