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September 26, 2018

A psychologist, John R. Sink, and his wife, Diane Sink, pled guilty to making false statements to Wyoming Medicaid.  According to the plea, between 2012 and 2016, the Sinks submitted over $6.2 million in claims for group therapy, knowing that the activities provided and billed for did not qualify as group therapy.  In addition, the hours billed did not accurately report the time each Medicaid beneficiary was actively participating in any activities, and the Sinks were not using up-to-date treatment plans to guide each Medicaid beneficiaries treatment as required by Wyoming Medicaid.  USAO D. Wy.

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

September 26, 2018

Health Management Associates, LLC (HMA)—now part of Community Health Systems Inc. (CHS)—has agreed to pay a combined $260 million to settle civil and criminal charges of defrauding Medicare, Medicaid, and TRICARE and violating the Anti-Kickback Statute, the Stark Law, and False Claims Act. The alleged fraud was revealed by eight whistleblowers and involved paying kickbacks to doctors for patient referrals, pressuring doctors to meet emergency patient admission quotas, billing outpatient or observational services as inpatient services, and inflating the cost of emergency services. The eight whistleblowers have been granted a combined $27 million award so far. DOJ; USAO EDPA; USAO SDFL; USAO WDNC

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Other Government Health Programs, Whistleblower Rewards,

September 24, 2018

The owner and operator of several Superdrugs pharmacies in Queens, New York, was charged with submitting false claims to Medicare Part D and Medicaid for prescription drugs that were not dispensed, were not prescribed as claimed, or not medically necessary.  The pharmacies allegedly received $7.9 million from Medicare and Medicaid based on the fraudulent claims.  DOJ

Tagged in: Lack of Medical Necessity, Medical Billing Fraud, Part D, Pharma Fraud,

September 19, 2018

A physician and two clinic operators were convicted after trial for charges arising from a $17 million Medicare fraud scheme.  The doctor, John Ramirez, provided medical orders falsely certifying the need for home-health services, which the other defendants then sold to to home-health agencies in the Houston, Texas area.  These agencies then used the false and fraudulent paperwork signed by Ramirez to submit false claims to Medicare for medical services that were not medically necessary or not provided.  DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

September 19, 2018

Calloway Laboratories, Inc.—a Massachusetts-based clinical laboratory—has been ordered to pay a civil judgment of $1,374,058 to settle claims first brought to light by a former employee in a whistleblower lawsuit. The laboratory allegedly violated the Anti-Kickback Statute, Stark Law, and False Claims Act over the course of six months by providing free testing supplies to doctors in exchange for referrals and then submitting reimbursement claims for testing arising from these improper referrals to Medicare and TRICARE. USAO EDKY

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

September 17, 2018

In the largest healthcare fraud case ever to come out of Mississippi, the co-owner of two Mississippi-based compounding pharmacies, Marco Bisa Hawkins Moran, has pleaded guilty to defrauding TRICARE of more than $22 million. As part of the fraud, Moran and others allegedly paid kickbacks to doctors and marketers to prescribe drugs for beneficiaries covered by TRICARE and other lucrative health benefit programs. Additionally, they allegedly selected formulas meant to maximize profits instead of benefit individuals, and submitted fraudulent reimbursement claims to TRICARE. The case spanned multiple states across the country, including California, Tennessee, Arkansas, and Connecticut, with twelve people charged and nine convicted so far. USAO SDMS

Tagged in: Compounding Pharmacy Fraud, Other Government Health Programs, Pharma Fraud,

August 10, 2018

Trinity Medical Pharmacy, LLP and several members of its leadership have agreed to pay $2,244,270.14 to settle allegations that it violated the False Claims Act by giving illegal kickbacks to patients and providers, billing TRICARE and other government programs for medical reimbursement claims arising from those kickbacks, and failing to disclose information that would have barred it from becoming a provider for Express Scripts, which provides pharmaceutical services for TRICARE. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud,

August 1, 2018

Early Autism Project, Inc. (“EAP”) agreed to pay the United States $8,833,615 to settle allegations brought by whistleblower and former employee of EAP, Olivia Zeigler, that it submitted false claims to TRICARE (a military insurance program) and South Carolina’s Medicaid program for therapy services for children with autism. The therapy services were misrepresented or were never provided. EAP allegedly also created a program under which it billed Medicaid for functions that were not related to therapy services at all and permitted its therapists to regularly bill for more hours than they actually provided therapy services. Olivia Zeigler will be awarded $435,000. DOJ

Tagged in: FCA Federal, FCA State, Medicaid, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 26, 2018

New York announced guilty pleas by transportation company 716 Transportation, Inc., its president, and one of its drivers, in connection with a $1.2 million Medicaid fraud scheme. The company and its president admitted to billing Medicaid for transportation services that were either never provided or that violated Medicaid rules and regulations. NY AG

Tagged in: Ambulance, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

July 20, 2018

Attorney General Barbara Underwood announced a six month jail sentence and $1.5 million in restitution payments for Arkady Goldin owner of Value Pharmacy, Inc. for defrauding the New York State Medicaid program. Mr. Goldin had pleaded guilty to second degree health care fraud in June for entering into a kickback arrangement with a former hospital employee to steer prescriptions to Value Pharmacy. Value then submitted false claims to Medicaid for medications it never dispensed to patients. NY AG

Tagged in: Medicaid, Pharma Fraud,

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