Archive

March 2, 2017

Detroit-area physician Aaron Goldfein pleaded guilty for his role in a $5.4 million Medicare fraud scheme involving phony physician visits and drug prescriptions.  As part of his plea, Goldfein admitted to being part of a scheme in which his co-conspirators would hold themselves out as licensed physicians and purport to perform physician home visits and other services for Medicare beneficiaries, although these co-conspirators were not licensed to practice medicine in Michigan.  Goldfein would then bill Medicare through Tri-City Medical Center as if he himself had completed these visits.  Goldfein also admitted to being part of a scheme in which he received kickbacks in exchange for writing home health prescriptions. DOJ

March 17, 2017

Two individuals have been ordered to pay $13.5 million for the deceptive marketing of medications and services relating to the treatment of erectile dysfunction at an unlicensed medical clinic in Framingham, Attorney General Maura Healey announced. The judgment also orders preventive measures to ensure future compliance with the law. Pursuant to the Suffolk Superior Court judgment, Kevin Hornsby, M.D., was ordered to pay $11 million in civil penalties and his wife, Heidi Hornsby, was ordered to pay $2.5 million. According to the AG’s complaint, Florida Men’s Medical Clinic, LLC (FMMC), Men’s Medical Clinic, LLC (MMC), Kevin Hornsby, MD and Heidi Hornsby, were responsible for the deceptive marketing of medications and services relating to the treatment of erectile dysfunction at an unlicensed medical clinic in Framingham that went by the names Massachusetts Men’s Medical Clinic, Massachusetts Men’s Medical and Men’s Medical Clinic. The defendants used various deceptive practices in widespread TV, print and radio advertising to market the erectile dysfunction services and treatments sold at their Framingham facility. According to the complaint links to PDF file, more than 4,000 consumers went to the unlicensed facility for care. MA

March 2, 2017

New York announced the sentencing of two pharmacy owners, a supervising pharmacist and ten corporations for defrauding several government-funded healthcare programs, including Medicaid and Medicare. An investigation revealed that on at least eight separate occasions between November 2013 and February 2014, the defendants paid patients hundreds of dollars in cash to forgo their prescription medications, the vast majority of which were to treat HIV. The defendants then submitted false claims to Medicare, Medicaid and Medicaid-managed care organizations and were reimbursed for distributing the medications, despite the fact that they were never dispensed to patients. Tarek Elsayed, 50, of Elmhurst Queens, the co-owner of 184th Street Pharmacy in the Bronx, was sentenced in Bronx County Supreme Court by the Honorable Stephen Barrett to one to three years in state prison. Previously, in August of 2016, Ahmed Hamed, 39, of Elmhurst Queens, the second co-owner of 184th Street Pharmacy, was sentenced to two to six years in state prison. In October of 2016, Mohamed Hassan Ahmed, 38, of Bayside, the supervising pharmacist at 184th Street Pharmacy, was sentenced to one to three years in state prison and was required to surrender his license to practice pharmacy. Collectively, the three defendants stole over $10 million from government-funded health care programs. In addition, the Attorney General’s Medicaid Fraud Control Unit (MFCU) reached a $4.1 million civil settlement agreement with defendant Elsayed and a $3.8 million civil settlement agreement with defendant Hamed. NY

February 24, 2017

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc., two Miami-area home health agencies, was sentenced to a 126 month prison term for his role in a $2.5 million Medicare fraud scheme.  The evidence at trial showed that Leon and his co-conspirators used the companies to submit false claims to Medicare based on services not medically necessary, not actually provided, and for patients procured through the payment of illegal kickbacks to doctors and patient recruiters.  DOJ

February 10, 2017

Dr. Paul B. Tartell, an ENT physician practicing in Plantation, Florida and his practice Paul B. Tartell, M.D., P.L., have agreed to pay $750,000 to resolve allegations that he violated the False Claims Act by billing for surgical endoscopies with debridement and laryngeal stroboscopies that were not provided or not medically necessary.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Theodore Duay, a former patient of Dr. Tartell.  Mr. Duay will receive a whistleblower award of $135,000 from the proceeds of the government's recovery.  DOJ (SDFL)

February 8, 2017

Florida-based Comprehensive Health Services, Inc., one of the country’s largest providers of workforce medical services, agreed to pay roughly $3.8 million to settle charges it violated the False Claims Act by double-billing and mischarging the government for medical services in connection with work it performed on an Internal Revenue Service contract.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by James J. Kerr, Jr.  He will receive a whistleblower reward of roughly $645,000 from the proceeds of the government’s recovery.  Whistleblower Insider

February 7, 2017

Florida physician Gary L. Marder, and the owner of the Allergy, Dermatology & Skin Cancer Centers in Port St. Lucie and Okeechobee, stipulated to a consent final judgment of over $18 million to settle False Claims Act allegations that Dr. Marder submitted claims to federal healthcare programs for medically unnecessary biopsies and radiation therapy services, radiation therapy services performed in contravention of standard practice regarding the amount of time between radiation treatments, and radiation therapy services performed without direct supervision and by unlicensed and/or unqualified physician assistants.  Dr. Kendall also allegedly submitted false claims to federal and state healthcare programs for laboratory services tainted by kickbacks to, and improper financial relationships with, Dr. Marder.  The allegations originated in a whistleblower lawsuit filed by Dr. Theodore A. Schiff under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (SDFL)

February 6, 2017

U.S. hospital service provider TeamHealth Holdings (as successor in interest to IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc.), agreed to pay $60 million to resolve allegations it violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed (a practice known as “up-coding”).  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist.  He will receive a whistleblower award of roughly $11.4 million.  DOJ

February 2, 2017

Pain management physician Dr. Robert Windsor, owner of National Pain Care, Inc. which owns pain management clinics in Georgia and Kentucky, agreed to the entry of a $20 million consent judgment to resolve allegations he violated the False Claims Act by billing federal health care programs for surgical monitoring services he did not perform and for medically unnecessary diagnostic tests.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Kris Frankenberg, Stephanie Herder and Bradley Davis.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government’s recovery.  Whistleblower Insider

February 17, 2017

A Wellesley-based dental provider and its billing agent have agreed to pay $1.5 million to Massachusetts’ Medicaid program (MassHealth) to resolve allegations of improper billing for visits to MassHealth members living in nursing homes. The settlement resolves allegations that dental provider Alec H. Jaret, DMD, PC d/b/a HealthDrive Dental Group and its billing agent, HealthDrive Corporation, overbilled MassHealth for nursing home visits. The AG’s Office filed a complaint against the defendants in March 2014 alleging that between July 2010 and September 2013, HealthDrive, on behalf of HealthDrive Dental Group, overbilled MassHealth for nursing home visits by charging a separate “house call” fee for multiple patients treated at the same facility on the same day. An investigation by the AG’s Office revealed that HealthDrive was paid for more than 34,700 excessive claims on a per-patient per-day basis, contrary to MassHealth’s regulations on dental house calls established in 2010. The parties have reached a civil settlement agreement pursuant to which HealthDrive and HealthDrive Dental Group will pay MassHealth $1,500,756 to resolve all claims. MA