Archive

April 24, 2017

Crittenton Hospital Medical Center and the Crittenton Cancer Center, together with their current owners Ascension Michigan and Ascension Health agreed to pay roughly $790,000 to resolve allegations they violated the False Claims Act by billing for medically unnecessary laboratory testing for patients who had been referred to Crittenton by Dr. Farid Fata and physicians in his office. In an earlier unrelated criminal matter, Fata pleaded guilty to health care fraud, conspiracy to pay and receive kickbacks, and promotional money laundering, and was sentenced to a term of 45 years in prison. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by an office administrator in Fata’s medical practice, Michigan Hematology-Oncology P.C. The whistleblower will receive a whistleblower award from the proceeds of the government's recovery. DOJ (EDMI)

April 20, 2017

Illinois-based drugstore giant Walgreen Co. agreed to pay $9.86 million to resolve allegations it violated the False Claims Act by submitting claims for reimbursement to California’s Medi-Cal program that were 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 former Walgreens pharmacist and a former pharmacy technician. They will receive a whistleblower award of roughly $2.3 million from the proceeds of the government's recovery. DOJ (EDCA)

April 20, 2017

Dr. Norman A. Brooks, a dermatologist and surgeon and owner of Skin Cancer Medical Center in Encino, agreed to pay roughly $2.7 million to resolve allegations he submitted bills to Medicare for Mohs micrographic surgeries for skin cancers that were medically unnecessary. The government alleged that Brooks falsely diagnosed skin cancer in some of his patients so that he could perform, and bill for, Mohs surgeries. The allegations originated in a whistleblower lawsuit by former employee Janet Burke. She will receive a whistleblower award of roughly $483,000 from the proceeds of the government's recovery. DOJ (CDCA)

April 11, 2017

Norman Regional Hospital Authority (d/b/a Norman Regional Health System) and certain employees and physicians of Norman Regional agreed to pay roughly $1.6 million to settle charges of violating the False Claims Act by submitting false claims to Medicare for radiological services performed without the proper supervision by a physician.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Norman Regional radiologist Dr. Lance Garber.  He will receive a yet-to-be-identified whistleblower award from the proceeds of the government's recovery. DOJ (WDOK)

April 10, 2017

Kentucky based nursing home operator Prestige Healthcare agreed to pay $995,500 to resolve allegations it violated the False Claims Act with regard to its role in an alleged scheme to falsely bill Medicare for unnecessary genetic testing.  According to the government, Prestige provided genetic testing company Genomix LLC with information on and access to Prestige nursing home patients without ensuring physician orders were obtained for the testing and where Prestige physicians were not aware of and did not agree with the medical necessity of the testing. DOJ (WDWI)

March 31, 2017

Tennessee based Exemplary Behavior, LLC and its principal, Andre Anderson, agreed to pay $20,000 to settle allegations they violated the False Claims Act by submitting false claims for payment to the Defense Health Agency’s TRICARE program for the provision of therapy services, including Applied Behavior Analysis (“ABA”) to children with Autism Spectrum Disorder (“ASD”).  Specifically, the settlement resolves charges that Exemplary Behavior submitted false claims to TRICARE as a result of their (1) double billing for services rendered; (2) billing for services not rendered by the billing provider; (3) providing group therapy while billing for individual therapy; and (4) billing for services, including ABA therapy, that were not actually provided. DOJ (MDTN)

April 20, 2017

California announced a $9.8 million settlement with Walgreens, one of the largest drugstore chains in the United States. The settlement involved allegations that Walgreens failed to adhere fully to requirements imposed by California law for the dispensing of certain prescriptions drugs under Medi‑Cal. The settlement is the result of lawsuits filed by whistleblowers and investigated and resolved by federal and state prosecutors. The lawsuits alleged that for more than five years, Walgreens falsely certified that it had complied with diagnosis-related requirements for the lawful dispensing of prescriptions to Medi‑Cal patients. Through the Bureau of Medi‑Cal Fraud and Elder Abuse (BMFEA), the Attorney General’s office regularly works with whistleblowers and law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi‑Cal program. False claims lawsuits pursued by the Attorney General in the last two years have recovered tens of millions of dollars from some of the nation’s largest pharmaceutical companies for allegations of improper marketing, falsifying reports to inflate prices, and other wrongful practices. CA

March 13, 2017

Massachusetts-based Charles River Laboratories International Inc. agreed to pay $1.8 million to settle claims it violated the False Claims Act by improperly charging for labor and other associated costs not actually provided on certain National Institutes of Health contracts relating to the provision of laboratory animals to the NIH. DOJ

March 6, 2017

Simon Hong, owner of Los Angeles-based JH Physical Therapy Inc., was sentenced to 63 months in prison and to pay roughly $2.4 million in restitution, for his role in a $3.4 million Medicare fraud scheme that involved billing for occupational therapy services that were not medically necessary and not provided.   Hong admitted billing Medicare for occupational therapy services when what were provided instead were acupuncture and massage services, not reimbursable by Medicare.  Hong further admitted directing co-conspirator therapists to falsify medical records to make it appear as if the services billed actually had been provided. DOJ

March 3, 2017

Rex Duruji, an unlicensed medical professional posing as a physician, was convicted for his participation in a $1.3 million Medicare fraud scheme.  The evidence presented at trial showed that Duruji posed as a physician to induce Medicare beneficiaries to sign up for fraudulent home-health services with Koby Home Health that were not actually provided and paid illegal cash kickbacks to the beneficiaries for those claims. DOJ