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December 22, 2017

Kmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation, agreed to pay $32.3 million to settle allegations that Kmart violated the False Claims Act through Kmart pharmacies offering discounted generic drug prices to cash-paying customers through various club programs without disclosing those prices when reporting to federal health programs its usual and customary prices. Usual and customary pricing is typically used by Medicare and the other federal health programs to establish reimbursement rates. The settlement is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by James Garbe. He will receive a whistleblower award of $9.3 million. DOJ

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

December 21, 2017

Florida-based Haven Hospice agreed to pay roughly $5 million to resolve allegations that Haven violated the False Claims Act by knowingly billing the government for medically unnecessary and undocumented hospice services. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Haven employee Dr. John Simons. Dr. Simons will receive a whistleblower award of roughly $900,000 from the proceeds of the government's recovery. DOJ (MDFL)

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

December 19, 2017

Two physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million to settle charges of violating the False Claims Act and Anti-Kickback Statute for allegedly receiving kickbacks in exchange for patient referrals to hospitals owned by the now-defunct Health Management Associates. Dallas-based EmCare agreed to pay $29.6 million to resolve allegations it received remuneration from HMA to recommend patients be admitted to HMA hospitals on an inpatient basis when the patients should have been treated on an outpatient basis. In a separate settlement, Pennsylvania-based Physician's Alliance agreed to pay $4 million for allegedly accepting illegal remuneration from HMA to refer patients to two HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center. The allegations originated in whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Drs. Thomas Mason and Stephen Folstad brought the qui tam suit against EmCare and will receive a whistleblower award of roughly $6.2 million from the proceeds of the government's recovery. Former HMA hospital executives George E. Miller and Michael J. Metts brought the qui tam suit against Physician's Alliance and will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Lack of Medical Necessity, Multiple Whistleblowers and First-to-File, Whistleblower Case, Whistleblower Rewards,

December 14, 2017

Texas-based DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with severe kidney disease, agreed to pay $63.7 million to resolve charges of violating the False Claims Act by billing Medicare for prescription medications never shipped, shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent. The settlement also resolves allegations that DaVita paid financial inducements to Medicare beneficiaries in violation of the Anti-Kickback Statute. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by two former DaVita employees Patsy Gallian and Monique Jones. The whistleblowers will receive an award of $2.1 million from the proceeds of the government's recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 14, 2017

Mississippi-based Region 8 Mental Health Services agreed to pay roughly $7 million resolve charges of violating the False Claims Act allegations by submitting claims for services not provided or not provided by qualified individuals as part of its preschool Day Treatment program. It is believed to be the largest False Claims Act healthcare settlement in the history of the State of Mississippi. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Region 8 employee. The whistleblower will receive an award of more than $1 million from the proceeds of the government's settlement. DOJ (SDMS)

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

December 12, 2017

Mobile imaging companies PDQ Imaging Services, LLC, PDQ Ultrasound Services, LLC, PDQ Mobile X-Ray Services, PDQ Mobile X-Ray, LLC, along with their owners Dennis Whitsell and Jonathan Graham Lane, agreed to pay $300,000 to settle charges of violating the False Claims Act and Anti-Kickback Statute by improperly billing Medicare for transportation charges related to portable x-ray services and paying kickbacks to skilled nursing facilities in exchange for patient referrals. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Kevin P. McDonough and Boyd K. Billington. They will receive a whistleblower award of roughly $60,000 from the proceeds of the government's recovery. DOJ (EDTX)

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

December 12, 2017

Med-Fast Pharmacy, Inc. agreed to pay roughly $2.7 million to resolve both criminal and civil charges of violating the False Claims Act relating to the conduct of Iserve Technologies, Inc., a company co-located with and operated out of Med-Fast, filling prescriptions for nursing homes with recycled unused drugs that were commingled with drug stocks on hand at Med-Fast’s Institutional Pharmacy. The settlement also resolves allegations that Med-Fast sought Medicare and Medicaid reimbursement for the retail-packaged version of diabetes testing strips while actually supplying patients with cheaper mail-order-packaged version of the same strips. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ (WDPA)

Tagged in: Healthcare Fraud, Medical Billing Fraud, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 8, 2017

Louisiana-based Iberiabank Corporation, Iberiabank and Iberiabank Mortgage Company agreed to pay roughly $11.7 million to resolve allegations they violated the False Claims Act by falsely certifying they were complying with Federal requirements in order to obtain insurance on mortgage loans from the Federal Housing Administration.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Iberiabank employees Kelley R. Shackleford and Karen Mills.  They will receive a whistleblower award of roughly $2.2 million from the proceeds of the government's recovery.  DOJ

Tagged in: FCA Federal, Financial Institution Fraud, Housing and Mortgage Fraud, Whistleblower Case, Whistleblower Rewards,

December 1, 2017

Pine Creek Medical Center LLC, a physician-owned hospital serving the Dallas/Fort Worth area, agreed to pay $7.5 million to resolve claims it violated the False Claims Act and Anti-Kickback Statute by paying physicians kickbacks in the form of marketing services in exchange for surgical referrals.  Specifically, Pine Creek allegedly paid for advertisements on behalf of the physicians as well as radio and television advertising, pay-per-click advertising campaigns, billboards, website upgrades, brochures, and business cards, and other forms of marketing to induce physicians to refer patients to Pine Creek for medical services.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by former Pine Creek employees Suzanne Scott and Savannah Sogar.  They will receive a whistleblower award of $1,125,000 from the proceeds of the government's recovery.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

December 1, 2017

Skin Care Doctors, P.A. and its founder and CEO Michael J. Ebertz, M.D., agreed to pay $850,000 to resolve allegations of violating the False Claims Act by submitting false claims to Medicare in connection with certain dermatology products and procedures.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a doctor who formerly worked with Ebertz.  The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery.  DOJ (DMN)

Tagged in: FCA Federal, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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