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September 5, 2017

National dental chain Dental Dreams, LLC agreed to pay $1.375 million to resolve allegations it improperly billed the Massachusetts Medicaid program for unnecessary and unjustifiable dental procedures.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dental Dreams former employee.  The whistleblower will receive an award from the proceeds of the government's recovery.  DOJ (DMA)

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

September 1, 2017

New Mexico-based Christus St. Vincent Regional Medical Center and its partner Texas-based Christus Health agreed to pay $12.24 million to resolve allegations they violated the False Claims Act by making illegal donations to county governments which were used to fund the state share of Medicaid payments to the hospital.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Los Alamos County, New Mexico Indigent Healthcare Administrator.  The whistleblower will receive an award of $2.25 million from the proceeds of the government's recovery. DOJ

Tagged in: FCA Federal, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

November 15th, 2017

New York announced the sentencings of Kenneth Cohn, Sharon Cohn, and Yellow Medi-Van and Taxi, Inc., for stealing hundreds of thousands of dollars in Medicaid funds and knowingly operating transportation services without Worker’s Compensation insurance. At sentencing in Broome County Court, the Cohns forfeited and released $455,604 currently being withheld by the New York State Department of Health, to the Attorney General’s Medicaid Fraud Control Unit. Each defendant also agreed to pay $50,000 in restitution, for a total of $100,000. Kenneth Cohn was sentenced to five years’ probation, and Sharon Cohn was sentenced to one year conditional discharge. Yellow Medi-Van and Taxi, Inc. was sentenced to three years conditional discharge. NY

Tagged in: Healthcare Fraud, Medicaid,

October 16, 2017

Louisiana announced the arrests of three New Orleans women as a result of an investigation exposing over $2 million in Medicaid Fraud. Lanice Stamps, 44 of New Orleans and owner of A New Direction Support Services, was arrested on 10 counts of Medicaid fraud for allegedly providing false and fraudulent claims for behavioral health services not rendered. Many recipients were fraudulently diagnosed as moderately mentally retarded or severely autistic so that the claims submitted could be billed at a higher level and they had never received counseling services. LA

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

August 18, 2017

Illinois and other states announced a $465 million settlement between the federal government and states with Mylan Inc. and its wholly-owned subsidiary, Mylan Specialty L.P. (Mylan), to resolve allegations that Mylan knowingly underpaid rebates owed to the Medicaid program for EpiPen® and EpiPen Jr.® (EpiPen) dispensed to Medicaid beneficiaries. The settlement resolves allegations that from July 29, 2010 to March 31, 2017, Mylan submitted false statements to the Centers for Medicare and Medicaid Services (CMS) that incorrectly classified EpiPens under terms defined in the Rebate Statute and Rebate Agreement. Mylan also failed to report a "Best Price" to CMS for EpiPens, as directed by the same statute. As a result, Mylan submitted false statements related to EpiPens to CMS and the states for Medicaid rebate purposes and underpaid EpiPen rebates to the state Medicaid programs. IL, IA

Tagged in: Drug and DME Pricing, Healthcare Fraud, Medicaid, Pharma Fraud,

August 2, 2017

Atlanta-based pain management clinic Atlanta Medical Clinic and its owner Dr. Timothy Dembowski agreed to pay $250,000 to resolve charges they violated the False Claims Act by billing for services performed by a physician suspended from the Medicare program and administering foreign, non-FDA approved drugs, which are not eligible for reimbursement under the Medicare program.  DOJ (NDGA)

Tagged in: FCA Federal, Medicare, Provider Fraud,

July 24, 2017

Dr. James Norman, the owner and operator of Norman Parathyroid Center, agreed to pay $4 million to resolve allegations he violated the False Claims Act by billing Medicare for pre-operative examination services for which he had already received payment from the government.  These extra fees ranged from $150 to $750 for Florida residents, to $1,750 or more for patients who lived out-of-state, adding up to hundreds of thousands of dollars in illicit billing.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former patient of Dr. Norman, Myra Gross, and her husband, Dr. David Gross.  They will receive a whistleblower award of roughly $600,000 from the proceeds of the government's recovery.  DOJ (MDFL)

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

July 24, 2017

Tennessee-based Pain Management Group P.C. agreed to pay $312,000 to settle charges it violated the False Claims Act by billing for medically unnecessary urine drug tests and non-FDA approved pharmaceuticals Botox, Supartz, and Eufflexa, which the company purchased from foreign-based suppliers.  DOJ (MDTN)

Tagged in: Healthcare Fraud, Medicare, Provider Fraud,

July 14, 2017

Rodney Hesson and Gertrude Parker, owners of Nursing Home Psychological Services and Psychological Care Services, were respectively sentenced to 180 months and 84 months in prison and to respectively pay $13.8 million and $7.3 million in restitution for their involvement in a $25.2 million Medicare fraud scheme involving billing Medicare for psychological testing services that nursing home residents did not need or in some instances did not receive.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicare, SNF,

July 14, 2017

Narco Freedom, Inc., a former operator of outpatient chemical dependency clinics, Joining Hands Management Inc., an operator of short-term residences known as “three-quarter houses,” and Joining Hands co-owner Devorah Haigler, settled claims of violating the False Claims Act.  The government will receive a $50.5 million allowed claim in the Narco Freedom bankruptcy proceeding, and Joining Hands and Haigler will pay $300,000.  The government alleged the defendants engaged in a kickback scheme whereby Narco made monthly cash payments to Joining Hands in exchange for Haigler and others referring residents of Joining Hands three-quarter houses to NARCO outpatient programs.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act.  An unidentified whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)

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

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