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July 13, 2017

New York podiatrist Perrin D. Edwards pled guilty to health care fraud for illegally charging Medicare and private insurance companies for podiatry services he never provided and agreed to pay $410,000 to resolve charges of violating the False Claims Act.  DOJ (NDNY)

Tagged in: Medical Billing Fraud, Medicare, Provider Fraud,

July 7, 2017

Wal-Mart Stores Inc. agreed to pay $1.65 million to resolve allegations it violated the False Claims Act by submitting pharmacy claims to California’s Medi‑Cal program not supported by applicable diagnosis and documentation requirements.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a Wal-Mart pharmacist.  The whistleblower will receive a whistleblower award of roughly $264,000 from the proceeds of the government's recovery.  DOJ (EDCA)

Tagged in: Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

July 6, 2017

Pennsylvania hospice company Compassionate Care of Gwynedd Inc., and a subsidiary of New Jersey-based Compassionate Care Hospice Group Inc., agreed to pay $2 million to resolve allegations it violated the False Claims Act by providing unnecessary hospice services.  The government alleged the company admitted patients by using a diagnosis of “debility” that was not medically justified.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive an award of more than $350,000 from the proceeds of the government's recovery.  DOJ (DNJ)

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

July 5, 2017

Reliant Care Group, Reliant Care Management Company, Reliant Care Rehabilitative Services, and a number of Reliant affiliated skilled nursing facilities agreed to pay roughly $8.4 million to settle charges they violated the False Claims Act by billing Medicare for unnecessary physical, speech, and occupational therapy to nursing home residents.  DOJ (EDMO)

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

June 30, 2017

Dawn Bentley, a Detroit-area medical biller, was sentenced to 50 months in prison and to pay roughly $3.3 million for her role in a $7.3 million Medicare and Medicaid fraud scheme involving medical services that were billed to Medicare and Medicaid but not rendered as billed.  DOJ

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

June 29, 2017

Innovative Therapies, Inc. and its parent company Cardinal Health, Inc. agreed to pay roughly $2.7 million to settle charges they violated the False Claims Act by submitting false claims to Medicare through their marketing of certain negative pressure wound treatment devices as durable medical equipment when they knew these devices did not have the expected life of a durable device.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former ITI employee.  The whistleblower will receive an award of $488,700 from the proceeds of the government's recovery.  DOJ (MDTN)

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

June 28, 2017

Charles G. Landry, D.O. agreed to pay $133,464 to resolve allegations he violated the False Claims Act by knowingly submitting claims for certain evaluation and management services not eligible for Medicare payment.  DOJ (DME)

Tagged in: FCA Federal, Medicare,

June 26, 2017

Dr. Miguel Burgos, the medical director of four Florida infusion clinics, and Yosbel Marimon, the owner of the clinics, were sentenced respectively to 64 months and 90 months in prison for their roles in a $13.7 million Medicare fraud conspiracy that involved submitting claims for expensive infusion-therapy drugs that were never purchased, never provided and not medically necessary.  DOJ

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

June 26, 2017

AMI Monitoring Inc. (aka Spectocor), its owner Joseph Bogdan, Medi-Lynx Cardiac Monitoring LLC, and Medicalgorithmics SA, the current majority owner of Medi-Lynx, agreed to pay roughly $13.5 million to resolve allegations they violated the False Claims Act by billing Medicare for higher and more expensive levels of cardiac monitoring services than requested by the ordering physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Spectocor sales manager Eben Steele.  He will receive a whistleblower award of roughly $2.4 million from the proceeds of the government's recovery.  DOJ

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

August 4, 2017

Georgia announced a civil settlement with The Medical Center of Central Georgia, Inc., more commonly known as The Medical Center, Navicent Health (Navicent). Navicent agreed to pay to the United States and the State of Georgia $2,549,742 to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary. Additionally, Navicent’s current Corporate Integrity Agreement (CIA) will be heightened and extended to cover the newly resolved conduct. A CIA is an agreement between a private provider of services and the United States whereby the provider, at its own expense, institutes and maintains a program, overseen by the OIG with reviews by an independent review organization, to insure compliance with the laws and regulations regarding participation in federally funded programs. GA

Tagged in: FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

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