Archive

May 26, 2017

Abington Memorial Hospital agreed to pay $491,672, to resolve allegations it violated the False Claims Act through the conduct of employee forging physician signatures on forms submitted to Medicare for home care services. DOJ (EDPA)

May 23, 2017

New York endocrinologist Dr. Michael Esposito agreed to pay $100,000 to settle charges of violating the False Claims Act for billing Medicare despite his exclusion from all federal health care programs. DOJ (NDNY)

May 11, 2017

Benefits management company Carecore National LLC agreed to pay $54 million to settle charges of violating the False Claims Act by submitting Medicare and Medicaid claims for medical diagnostic procedures without properly assessing whether they were necessary or reasonable.  CareCore provides utilization management services including determinations of medical necessity to New York Medicaid Managed Care Organizations (MCOs). The agreement settles allegations that CareCore instituted a scheme to auto-approve or “Process As Directed” (“PAD”) hundreds of radiology service requests on a daily basis, deeming those diagnostic services as reasonable and medically necessary, even though there had been no evaluation of those cases by the appropriate medical personnel. Of the $54 million, $18 million will go to 20 state Medicaid programs. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (SDNY); NY, FL

May 8, 2017

Kansas medical equipment supplier Pos-T-Vac, Inc. agreed to pay $1 million to settle allegations it violated the False Claims Act by charging Medicare for vacuum supplies not medically necessary, lacking documentation of medical necessity, and/or not properly ordered by a physician. DOJ (DKS)

May 2, 2017

North Carolina-based Piedmont Pathology agreed to pay $601,000 to settle allegations it violated the False Claims Act by submitting false claims to Medicare and Medicaid for medically unnecessary procedures. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Piedmont pathologist Dr. Kim Geisinger. She will receive a whistleblower award of roughly $120,000. DOJ (WDNC)

May 2, 2017

Maine dentist Joseph W. Griffin agreed to pay $90,000 to resolve allegations he violated the False Claims Act by submitting submitted false claims to MaineCare (Maine’s Medicaid program) for dental services not rendered, were medically unnecessary, or were so inadequately documented in the patient’s medical record as to be unreviewable. DOJ (DME)

May 1, 2017

Kansas City area chiropractor Brian Schnitta and his clinic, Natural Way Chiropractic Center, agreed to pay roughly $1 million to settle allegations they violated the False Claims Act by charging Medicare for treatments for peripheral neuropathy not medically necessary or not otherwise covered by the program. DOJ (DKS)

May 1, 2017

Memphis-based Poplar Healthcare PLLC and Poplar Healthcare Management, LLC agreed to pay $897,640 to resolve allegations they violated the False Claims Act by billing the government directly and through a subsidiary known as GI Pathology for diagnostic tests not medically necessary. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Poplar pathologist Gordon Wang. He will receive a whistleblower award of roughly $206,000 from the proceeds of the government's recovery. DOJ (DRI)

April 28, 2017

New Jersey-based Quest Diagnostics Inc. agreed to pay $6 million to resolve charges that Berkeley HeartLab Inc., which Quest acquired in 2011, violated the False Claims Act by paying kickbacks to physicians and patients to induce the use of Berkeley for blood testing services and by charging for medically unnecessary tests. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Michael Mayes. He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ

April 27, 2017

Forrest S. Kuhn, Jr., M.D., a Kentucky physician specializing in allergy, asthma and immunology, agreed to pay roughly $750,000 to resolve allegations he violated the False Claims Act by submitting false claims to Medicare, Medicaid, and other government health care programs for allergy tests never performed. DOJ (WDKY)