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Page 49 of 79

September 27, 2017

South Carolina hospital AnMed Health agreed to pay over $7 million to resolve allegations it violated the False Claims Act by knowingly disregarding the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.  Specifically, the government alleged that AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former AnMed Health employee Linda Jainniney.  She will receive a whistleblower award of roughly $1.2 million from the proceeds of the government's recovery.  DOJ (NDGA)

Tagged in: FCA Federal, Hospital Fraud, Improper Medical Personnel, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

September 20, 2017

Miami physician Roberto A. Fernandez was sentenced to 97 months in prison and to pay $4.8 million in restitution for his role in a $4.8 million health care fraud scheme that involved the submission of false and fraudulent claims to Medicare and the illegal prescribing of controlled substances, including oxycodone and hydrocodone. DOJ

Tagged in: Lack of Medical Necessity, Pharma Fraud, Provider Fraud,

September 20, 2017

New Jersey-based durable medical equipment supplier R&V Medical Supplies LLC and its former owner Victor Saul agreed to pay $220,000 to settle charges of violating the False Claims Act by engaging in a scheme to defraud Medicare by billing for equipment not properly authorized by a physician or not actually provided. DOJ (EDPA)

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Devices and DME,

September 15, 2017

Valentina Kovalienko, the owner of Brooklyn medical clinics Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. was sentenced to 84 months in prison and ordered to forfeit roughly $29 million for her role in a $55 million health care fraud scheme.  As part of her guilty plea, Kovalienko acknowledged that her co-conspirators paid cash kickbacks to patients to induce them to attend her two clinics.  She also admitted submitting false and fraudulent claims to Medicare and Medicaid for services that were induced by prohibited kickback payments to patients or that were unlawfully rendered by unlicensed staff. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Improper Medical Personnel, Provider Fraud,

September 8, 2017

Galena Biopharma Inc. agreed to pay more than $7.55 million to resolve allegations it violated the False Claims Act by paying kickbacks to doctors to induce them to prescribe its fentanyl-based drug Abstral.  These included providing more than 85 free meals to doctors and staff from a single, high-prescribing practice; paying doctors thousands of dollars to attend an “advisory board,” and paying roughly $92,000 to a physician-owned pharmacy under a performance-based rebate agreement.  Two of the doctors who received remuneration from Galena were convicted and later sentenced to prison.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Lynne Dougherty.  She will receive a whistleblower award of more than $1.2 million from the proceeds of the government's recovery. DOJ

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

September 7, 2017

Connecticut substance abuse treatment provider the Hartford Dispensary and the Hartford Dispensary Endowment Corporation and its former CEO Paul McLaughlin agreed to pay $627,000 to resolve allegations they violated the False Claims Acts by falsely representing and certifying to federal and state authorities that Hartford Dispensary had a medical director, as defined by relevant regulations, who was performing the duties and responsibilities required by federal and state law.  The allegations originated in a whistleblower lawsuit filed by former Hartford Dispensary employees Russell Buchner and Charles Hatheway under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $113,000 from the proceeds of the government's recovery.  DOJ (DCT)

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

August 28, 2017

Oklahoma physician Dr. Gordon P. Laird agreed to pay $580,000 to settle allegations he violated the False Claims Act by submitting false claims to Medicare for services he did not provide or properly supervise.  He is a former owner and employee of the companies Blackwell Feet Plus, LLC, and Feet Plus, LLC, which later did business as Prevention Plus. DOJ (WDOK)

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

August 24, 2017

Nashville-based transportation service provider Employment & Assessment Solutions, Inc. and its principal Chris Manus agreed to pay $550,000 to settle allegations they violated the False Claims Act by submitting false claims to TennCare for transportation services which were never provided, including claims for patients who were actually incarcerated or hospitalized at the time of the purported transport. DOJ (MDTN)

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

August 3, 2017

The Medical Center of Central Georgia, Inc. (d/b/a The Medical Center, Navicent Health) agreed to pay roughly $2.6 million to resolve allegations it violated the False Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Navicent paramedic Andre Valentine.  He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (MDGA)

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

November 17th, 2017

New York announced the indictment of Hin T. Wong ("Wong"), 49, of Manhattan, Mery Gooden, 58, of the Bronx, and three pharmacies. The indictment charges Wong, the owner of three Manhattan pharmacies – New York Pharmacy Inc. ("NY Pharmacy"), NYC Pharmacy Inc. ("NYC Pharmacy"), and New York Healthfirst Pharmacy Inc. ("NY Healthfirst") – for defrauding several government-funded healthcare programs, including Medicaid and Medicare, by falsely billing prescription refills and stealing over $3 million in reimbursement for medication they did not dispense. Wong was indicted for Grand Larceny in the First Degree, a class "B" felony, and other crimes. In addition, Mery Gooden, a pharmacist at NYC Pharmacy, was indicted for Grand Larceny in the Second Degree and other related crimes. NY

Tagged in: FCA State, Medical Billing Fraud, Pharma Fraud,

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