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July 17, 2017

Former Olympia Therapy Inc. employee Vladimir Trakhter and former Tridia Hospice Care Inc. employees Paula Bourne and La’Tasha Goodwin will collectively receive a whistleblower award of more than $3.6 million from the roughly $19.5 million Olympia, Tridia and Foundations Health Solutions Inc. agreed to pay to resolve allegations they violated the False Claims Act by submitting to Medicare claims for medically unnecessary rehabilitation therapy services and for hospice services to patients not eligible for the Medicare benefit, and by soliciting and receiving kickbacks to refer patients from their skilled nursing facilities to home health care provider Amber Home Care LLC.

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

July 17, 2017

New York-based home health care company Visiting Nurse Service of New York and its subsidiaries VNS Choice and VNS Choice Community Care agreed to pay roughly $4.4 million to settle charges of violating the False Claims Act by improperly collecting monthly Medicaid payments for 365 Medicaid beneficiaries whom VNS Choice failed to timely disenroll from the VNS Choice Managed Long-Term Care Plan.  Once VNS disenrolled the members, it did not repay Medicaid for the funds it had improperly received. By knowingly retaining overpayments for many of these members for more than 60 days, the VNS entities violated both the federal and state false claim acts. As a result, New York State will receive $2.63 million as part of the settlement agreement.The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by an undisclosed whistleblower.  The whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)  NY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Whistleblower Case, Whistleblower Rewards,

June 16, 2017

Pennsylvania-based skilled nursing facility operator Genesis Healthcare Inc. agreed to pay roughly $53.6 million to settle charges that companies and facilities acquired by Genesis violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Joanne Cretney-Tsosie, Jennifer Deaton, Kimberley Green, Camaren Hampton, Teresa McAree, Terri West, and Brian Wilson, former employees of companies acquired by Genesis. They collectively will receive a whistleblower award of $9.67 million from the proceeds of the government's recovery. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, SNF, Whistleblower Case, Whistleblower Rewards,

June 13, 2017

New Jersey doctor Robert Claude McGrath and his chiropractor son Robert Christopher McGrath admitted to conspiring to defraud Medicare by using unqualified people to give physical therapy to Medicare recipients. Together with their practice, the Atlantic Spine & Joint Institute, they also agreed to pay $1.78 million to resolve allegations they violated the False Claims Act through the illegal billings. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Linda Stevens, a former billing manager at Atlantic Spine. She will receive a whistleblower award of roughly $338,200 from the proceeds of the government's recovery. DOJ (DNJ)

Tagged in: Chiropractic, Healthcare Fraud, Improper Medical Personnel, Medicare, Whistleblower Case, Whistleblower Rewards,

June 7, 2017

Texas-based medical and physical therapy provider Union Treatment Center agreed to pay $3 million to settle charges it violated the False Claims Act by defrauding the federal workers’ compensation (FECA) program.  The company will also waive claims for payment exceeding $1.6 million and be permanently excluded from participating in federal health care programs.  According to the government, UTC fraudulently billed the FECA program for services it did not render, routinely overcharged for medical examinations, falsely inflated the time patients spent in therapy, billed for unnecessary services and supplies, and paid kickbacks in exchange for patient referrals.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (WDTX)

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

May 31, 2017

Massachusetts-based eClinicalWorks, one of the country's largest vendors of electronic health records software, along with certain of its employees, agreed to pay $155 million to resolve charges the company violated the False Claims Act by misrepresenting the capabilities of its software.  The company also allegedly paid kickbacks to certain customers in exchange for promoting its product.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement.  He will receive a whistleblower award of roughly $30 million from the proceeds of the government's recovery. DOJ

Tagged in: Contract Non-Compliance, Electronic Health Records, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

May 30, 2017

Florida-based managed care service provider Freedom Health Inc. agreed to pay roughly $32 million to settle charges it violated the False Claims Act by engaging in illegal schemes to maximize its Medicare Advantage plan payments from the government.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Freedom Health employee and Constantine Cannon client Darren D. Sewell.  He will receive a yet-to-be-determine whistleblower award from the proceeds of the government's recovery.  Whistleblower Insider

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Risk Adjustment Fraud, Whistleblower Case, Whistleblower Rewards,

May 26, 2017

Kuwaiti-based Agility Public Warehousing Co. KSC agreed to globally resolve criminal, civil, and administrative cases arising from allegations that it overcharged the United States when performing contracts with the Department of Defense to supply food for U.S. troops from 2003 through 2010.  As part of the settlement, Agility agreed to pay $95 million to resolve civil fraud claims, to forgo administrative claims against the United States seeking $249 million in additional payments under its military food contracts, and to plead guilty to a criminal misdemeanor offense for theft of government funds.  According to the government, Agility overcharged the DOD for locally available fresh fruits and vegetables that Agility purchased through the Sultan Center Food Products Company, K.S.C. (TSC).  Agility charged the full amount of TSC’s invoices despite agreeing with TSC it would pay 10 percent less than the amount billed.  The government further alleged Agility failed to disclose and pass through rebates and discounts it obtained from U.S.-based suppliers. The allegations originated in a whistleblower lawsuit filed against Agility and TSC under the qui tam provisions of the False Claims Act by Kamal Mustafa Al-Sultan, a former vendor of Agility.  Mr. Al-Sultan will receive a whistleblower award of $38.85 million from the proceeds of the government's recovery. DOJ

Tagged in: Defendants, Defense Contract Fraud, Falsifying Invoices, FCA Federal, Whistleblower Case, Whistleblower Rewards,

May 18, 2017

Missouri health care providers Mercy Hospital Springfield and its affiliate Mercy Clinic Springfield Communities agreed to pay $34 million to settle charges they violated the False Claims Act by engaging in improper financial relationships with referring physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Mercy physician Dr. Viran Roger Holden.  Dr. Holden will receive a whistleblower award of $5,440,000 from the proceeds of the government's recovery. DOJ

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

May 16, 2017

Austin-based Financial Freedom agreed to pay more than $89 million to resolve charges it violated the False Claims Act and the Financial Institutions Reform, Recovery, and Enforcement Act of 1989 (FIRREA) in connection with its participation in a federally insured Home Equity Conversion Mortgages or "reverse mortgage" program.  According to the government, Financial Freedom sought to obtain insurance payments for interest from the Federal Housing Administration despite failing to properly disclose the mortgagee was not eligible for such interest payments because it had failed to meet various deadlines relating to appraisal of the property, submission of claims to HUD, and pursuit of foreclosure proceedings.  The allegations originated in a whistleblower declaration filed pursuant to FIRREA by Sandra Jolley, a consultant for the estates of borrowers who took out HECM loans.  She will receive a whistleblower award of $1.6 million from the proceeds of the government's recovery. DOJ

Tagged in: FCA Federal, FIRREA, Housing and Mortgage Fraud, Whistleblower Case, Whistleblower Rewards,

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