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May 11, 2023

GCI Communications Corp. has agreed to pay $40 million to resolve a whistleblower case by its former Director of Business Administration, which alleged the company violated the False Claims Act by failing to comply with competitive bidding regulations for the FCC’s Rural Health Care Program.  In order to participate in the program—which awards $570 million in subsidies annually to bring critical telecommunications services to rural healthcare providers—GCI was subject to regulations governing the prices it could charge these providers.  However, GCI charged inflated rates to a provider in Alaska, thereby receiving higher subsidy payments than it was entitled to.  For launching a successful enforcement action, whistleblower Robert Taylor will receive a $6.4 million share of the settlement.  DOJ

Tagged in: FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

April 28, 2023

Joyce Agu, of Sugar Land, TX, will spend 60 months in prison and will pay over $3 million in restitution for conspiring to pay and receive kickbacks for services billed to Medicare. Agu paid others to certify that her clients were eligible for home health services, which they were not, but she used the certifications anyway as a basis to submit false claims to Medicare. TX AG

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

April 20, 2023

Dr. Paul S. Koch, Koch Eye Associates, and Claris Vision violated the False Claims Act by paying kickbacks to optometrists who referred their patients to Koch and his companies for laser-assisted cataract surgery. Over a five-year period, from 2013 to 2017, Koch and his practices submitted false claims to Medicare based on those kickbacks. Koch will pay nearly $1.2 million to resolve the qui tam whistleblowers’ claims, and the two whistleblowers will receive $256,534.84 from the settlement. USAO RI

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

April 20, 2023

Miami doctors Lawrence Alexander and Dean Zusmer were sentenced to 33 months and 96 months in prison, respectively, for their scheme to defraud Medicare of $31 million. Zusmer, a chiropractor and DME company owner, paid kickbacks to acquire patient referrals and signed doctors’ orders, using overseas call centers to solicit unnecessary prescriptions from patients and telemedicine companies. Alexander, an orthopedic surgeon and co-owner of another DME company, concealed his participation by putting the DME company in the name of one of his family members. The companies received over $15 million from Medicare through their fraud. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare, Provider Fraud,

April 17, 2023

Sibley Hospital and parent company Johns Hopkins Health System will pay $5 million to resolve allegations of Stark Law violations. Over a four-year period, from 2008 to 2011, Sibley billed Medicare for ten cardiologists’ services to whom they were already paying compensation above fair market value. The Stark Law prohibits such an arrangement, to ensure that medical decision-making is not influenced by improper financial incentives but instead is based on the patient’s best interests. Sibley and Johns Hopkins self-disclosed the impropriety. DOJ

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

April 14, 2023

Rudean Weir and Jerome Weah will spend 30 and 46 months in prison, respectively, for defrauding the Enhanced One Shot Deal, a New York City Human Resources Administration program which provides cash assistance to homeless veterans seeking permanent housing. Weir and Weah submitted over 340 fraudulent EOSD applications using fake documentation and residency information and received approximately $5.4 million from the program as a result. Both defendants were ordered to pay $5.4 million in restitution. Weir will forfeit nearly $3.8 million, including his interest in two bank accounts, and six real estate properties. Weah will forfeit nearly $2.2 million, including his interest in two bank accounts and one real estate property. SNDY

Tagged in: Criminal Proceedings, FCA Federal, Government Programs Fraud,

April 13, 2023

Adobe Inc. will pay $3 million to resolve false claims allegations it paid kickbacks under its Solution Partner program to companies that had a relationship with the government, potentially influencing federal purchases of Adobe software. Over a ten-year period, Adobe allegedly paid companies a percentage of the purchase price, running afoul of the anti-kickback provisions, and causing false claims to be submitted to federal agencies. The three whistleblowers—all former Adobe managers—will receive $555,000 for exposing the fraud. DOJ

Tagged in: FCA Federal, Government Procurement Fraud, Whistleblower Case, Whistleblower Rewards,

April 4, 2023

From 2014 to 2022, medical testing company Genotox Laboratories Ltd. paid kickbacks to their “1099” representatives, calculated as a percentage of the revenue Genotox received from Medicare, the Railroad Retirement Board, and TRICARE billings for testing orders facilitated or arranged for by these representatives. In addition to the kickbacks, Genotox also allowed providers to create “custom profiles” to pre-select the tests to order for their patients, often resulting in medically unnecessary testing, such as definitive drug testing for 22 or more drug classes. Genotox will pay $5.9 million, and Genotox’s former billing manager—the whistleblower in this qui tam action—will receive approximately $1 million. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 30, 2023

Pharmacist Gisele Nguyen will pay over $3.9 million for fraudulently billing Medicare for medications that were never dispensed. For at least a 5-year period, from 2014 to 2018, Nguyen, dba Natico Pharmacy, submitted fraudulent claims for prescriptions that were never dispensed, and inventory records reflected that the pharmacy did not purchase enough of the medications from wholesalers to meet the fraudulent demand. DOJ

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

March 29, 2023

Michigan-based Covenant Healthcare System and two physicians, neurosurgeon Dr. Mark Adams and electrophysiologist Dr. Asim Yunus, have agreed to pay $69 million and about $406,500 and $346,000 respectively to resolve allegations of violating the Anti-Kickback Statute, Stark Law, and False Claims Act.  Covenant allegedly provided Dr. Yunus and five other physicians medical directorship roles, employed Dr. Adams, forgave rent payments from another physician, and permitted a physician group to secure a lease on advantageous terms in exchange for referrals.  Covenant then submitted false claims based on those referrals to Medicare, Medicaid, and TRICARE.  The claims were first raised by Dr. Stacy Goldsholl in a qui tam suit; Goldsholl will receive over $12 million from the three settlements.  USAO EDMI

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

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