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January 22, 2021

The estate of Dr. Patrick T. Hunter has agreed to pay more than $1.7 million to resolve allegations that the urologist, who passed away in 2019, submitted false claims to Medicare and TRICARE for medically unnecessary procedures and received improper payments for them from the Orlando Center for Outpatient Surgery.  Between 2010 and 2016, Dr. Hunter allegedly performed the lithotripsy procedures, which break up kidney stones, on patients who either did not have kidney stones or were not medically indicated for them.  For initiating the successful qui tam suit, whistleblower Scott Thompson will receive a relator’s share of $385,000.  USAO MDFL

December 21, 2020

DME provider Apria Healthcare Group, Inc. and Apria Healthcare LLC will pay $40.5 million to settle allegations brought in a qui tam action filed by three former Apria employees that they improperly billed government healthcare programs for beneficiary rentals of non-invasive ventilators (“NIVs”) that were not medically necessary or which were provided with improper waivers of patient co-payments.  Medicare pays as much as $1,400 a month for NIVs, and providers are required to monitor patient usage of NIVs and stop billing when the NIVs are no longer being used.  Apria respiratory therapists failed to monitor patient NIV usage and even when Apria knew that patients were no longer using the NIVs, Apria often did not take steps to stop seeking payment.  In addition, Apria sales staff steered doctors and beneficiaries to use NIVs when less-expensive alternatives were available, and routinely waived co-payments for NIV patients without making an assessment of the patient’s financial need.  USAO SDNY; CA AG; FL AG

December 21, 2020

Substance abuse treatment provider A.R.E.B.A.-CASRIEL, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (“ACI”) and its owner, Steven Yohay, agreed to pay a total of $6 million to resolve federal and New York state claims that they defrauded Medicaid including through the payment of kickbacks and other fraudulent conduct in connection with the enrollment of Medicaid beneficiaries into ACI’s inpatient treatment program.  Defendants allegedly employed drivers who were compensated in part based on the number of patients they recruited, to target homeless individuals to enroll in ACI’s inpatient treatment program by offering food, cash, and money to purchase drugs, and/or alcohol. In addition, ACI unlawfully paid a patient recruiter, and enrolled Medicaid patients who had not been evaluated by a qualified healthcare professional, including by copying a physician’s signature.  The government’s investigation was initiated by a whistleblower complaint filed by a former employee, who will receive an undisclosed amount of the settlement.  USAO SDNY; NY

December 16, 2020

Texas resident Rodney Mesquias, the former owner and officer of hospice services provider Merida Group, was sentenced to 20 years in prison following his conviction on fraud charges.  According to the evidence at trial, Mesquias falsely told thousands of individuals and their families that they had less than six months to live, so that he could enroll them in hospice programs, denying them from accessing curative care.  Mesquias also paid kickbacks to physicians for referring patients with long-term diseases such as Alzheimers and dementia.  Over  nearly ten years, Mesquias’ scheme resulted in the submission of $150 million in false and fraudulent claims for medically unnecessary services.  DOJ

November 24, 2020

Florida-based Doctor’s Choice Home Care, Inc. and its founders and former top executives Timothy Beach and Stuart Christensen have agreed to pay a combined $5.15 million to settle qui tam suits filed under the False Claims Act by former employees—one by Corina Herbold, and the other by Sara Billings, Misty Sykes, and Marina Eschoyez-Quiroga.  In violation of the Anti-Kickback Statute and the Stark Law, the home health agency had allegedly set up sham medical director agreements with physicians to pay them for referrals, linked employee bonuses to referrals made by physician spouses, and provided medically unnecessary services to Medicare patients in order to avoid decreased reimbursements triggered by fewer than five skilled service visits.  To settle the allegations, Doctor’s Choice will pay over $4.5 million, while Beach and Christensen will pay $647,000 each.  Billings, Sykes, and Eschoyez-Quiroga will jointly receive $145,000 of the settlement proceeds; Herbold’s share has yet to be determined.  DOJ; USAO MDFL

October 21, 2020

Purdue Pharma LP agreed to criminal fines and forfeitures totaling $5.544 billion following its guilty plea on charges arising from its manufacture and sale of opioid products.  Purdue falsely represented to the DEA that they maintained an effective anti-diversion program while continuing to market opioid products to healthcare providers that it had reason to believe were diverting opioids, aided and abetted the dispensing of opioids without a legitimate medical purpose, paid doctors to induce them to prescribe Purdue’s products, and paid an EHR company to boost the presence of Purdue’s products on the EHR system.  Purdue will receive a credit of up to $1.775 billion based on its prior settlements with state and local entities.  In addition to the criminal fines and forfeitures, a civil settlement provides the U.S. with an allowed claim of $2.8 billion to resolve claims that the company caused the submission of false claims to federal healthcare programs.  Individual members of the Sackler family, which owns Purdue, separately agreed to pay $225  million to resolve claims arising from their approval of a marketing program aimed at extreme high-volume prescribers and their transfer of assets into Sackler family holding companies and trusts.   DOJ

October 16, 2020

Massachusetts home health agency Altranais Home Care, LLC and its owners, Constant Ogutt and Shakira Lubega, will pay $3.1 million to resolved claims that they submitted false claims to the state’s Medicaid program, MassHealth.  According to the state, the defendants billed for services for which they did not have a physician-authorized plan of care.  Mass

October 2, 2020

Advanced Pain Management Holdings, Inc. and its subsidiaries will pay $1 million to resolve claims brought by a whistleblower under the False Claims Act.  Defendants, which run ambulatory surgical centers, were alleged to have violated the Anti-Kickback Statute by improperly gifting incentive stock shares to non-employee physicians allegedly as a reward for past and anticipated referrals to APMH facilities, and by paying those physicians “medical director” fees tied to the volume of procedures at APMH facilities, without proper documentation of the agreement.  In addition, defendants were alleged to have performed unnecessary confirmatory urine drug testing on patients.  USAO ED WI

September 29, 2020

Laredo optometrist David Mora will pay $3.23 million and enter into a corporate integrity agreement to resolve claims that he submitted false claims to Medicare between 2013 and 2019.  Mora allegedly billed for services including punctal plug insertion, sensorimotor testing, vision therapy, and amniotic membrane placement, where the patient’s condition did not warrant the service as medically necessary or reasonable.  USAO SD TX
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