Archive

January 12, 2017

The Confederated Tribes of the Colville Reservation (CGT) agreed to pay roughly $246,000 to settle charges it violated the False Claims Act by submitting false claims to Medicaid seeking the reimbursement of mental health counseling services either not provided or not medically indicated or necessary. The CCT is a federally recognized, sovereign Indian tribe, with tribal offices located at Nespelem, Washington, on the Tribes’ reservation. DOJ (EDWA)

January 12, 2017

Texas announced a settlement with MB2 Dental Solutions (MB2) and 21 affiliated pediatric dental practices. MB2 agreed to pay the United States and the State of Texas $8.45 million for alleged violations of the federal False Claims Act (FCA) and the Texas Medicaid Fraud Prevention Act (TMFPA). Three lawsuits were resolved with this settlement alleging that MB2 knowingly submitted claims for children’s dental services which were either not performed or were provided after false identification was used. The claims also involved illegal kickbacks to Medicaid beneficiaries and their families, marketers and marketing entities. The allegations were brought to the attention of the U.S. and Texas authorities by whistleblowers who filed one lawsuit under the FCA and two under the TMFPA. TX

January 12, 2017

New York announced the indictment and arraignment of attorney Anthony Cornachio, 74, of Garden City as well as the indictment and arraignment of NRI Group, LLC. (“NRI”) and Canarsie A.W.A.R.E., Inc. (“Canarsie”), both Medicaid-enrolled drug treatment programs companies controlled by Cornachio. Also announced was the indictment and arraignment of three-quarter housing operators Yury Baumblit, 66, and Rimma Baumblit, 60, of Brooklyn, and their company Back on Track Group, Inc. In papers unsealed in New York State Supreme Court, Kings County, prosecutors allege that Yury Baumblit and Rimma Baumblit, in exchange for payments from Cornachio’s companies, forced residents of their three-quarter homes to attend treatment at NRI and Canarsie regardless of the residents’ actual need for drug treatment services or face eviction. All of the residences leased by Back on Track Group, Inc. and operated by Yury Baumblit and Rimma Baumblit as three-quarter homes were located in Kings County. During the course of this scheme, which dates back to at least 2013, Cornachio allegedly paid Back on Track Group, Inc. over $900,000.00 in illegal kickbacks. As a result of this kickback scheme, prosecutors allege that Cornachio, through NRI and Canarsie, submitted, and caused to be submitted, at least $1.7 million in false claims for reimbursement to Medicaid. These claims, prosecutors allege, were fraudulent because they resulted from illegal kickbacks and were often medically unnecessary. NY

December 28, 2016

Bay Sleep Clinic, its related businesses -- Qualium Corporation and Amerimed Corporation -- and their owners and operators, Anooshiravan Mostowfipour and Tara Nader, agreed to pay $2.6 million to settle allegations they fraudulently charged Medicare for diagnostic sleep tests and medical devices in violation of Medicare payment rules. The allegations originated in a whistleblower lawsuit filed by Elma F. Dresser under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of approximately $545,000 from the proceeds of the government's recovery. DOJ (NDCA)

December 15, 2016

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc. was convicted for his role in a $2.5 million Medicare fraud scheme. According to evidence presented at trial, Leon and his co-conspirators used the companies to submit false claims to Medicare that were based on services that were not medically necessary, not actually provided and for patients that were procured through the payment of illegal kickbacks to doctors and patient recruiters.  DOJ

December 13, 2016

Elite Lab Services, LLC, along with its husband-and-wife owners Gerard and Suzanne Dengler, agreed to pay $3.75 million to settle charges of their violating the False Claims Act through their billing Medicare for tens of thousands of miles that were never driven by Elite Lab’s personnel.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Elite Lab employee Karen Malcolm.  She will receive a whistleblower award of $787,500 from the proceeds of the government's recovery.  DOJ (EDTX)

November 23, 2016

Georgia pain management physician Dr. Anthony Clavo agreed to the entry of a consent judgment for $430,000 to resolve allegations he violated the False Claims Act by billing Medicare, Medicaid, and TRICARE for medically unnecessary services.  The allegations originated in a whistleblower lawsuit filed by Herretta Pickens and Teresa Williams, former employees of Dr. Clavo, under the qui tam provisions of the False Claims Act.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (NDGA)

December 14, 2016

Florida announced a million dollar settlement reached with an obstetrician and gynecologist in Ocala. Dr. Rasiklal Dhanji Nagda is a Medicaid provider and owner of Nagda Medical, Inc. According to Attorney General Bondi’s Medicaid Fraud Control Unit’s investigation, Nagda submitted more than 700 claims to Medicaid for intrauterine devices not approved by the Food and Drug Administration, and received reimbursements from the Medicaid program. Nagda allegedly used a credit card to order large quantities of Bayer’s Mirena IUDs from an online pharmacy, GetCanadianDrugs.com, on a monthly basis. FL

November 8, 2016

Niurka Fernandez and her son Roberto Alvarez were sentenced to 120 months and 30 months in prison, respectively, for their roles in spearheading a $9.5 million health care fraud conspiracy that targeted Medicare Part D.  In addition, Fernandez and Alvarez were ordered to pay respectively $9.5 million and $1.5 million in restitution and to forfeit the same amounts.  As part of her guilty plea, Fernandez admitted she co-owned and operated several pharmacies in the Miami area, including Calan Pharmacy & Discount Service LLC and Bertyann Corp. (doing business as Best Pharmacy), for the purpose of submitting false and fraudulent claims through Medicare Part D by paying kickbacks to Medicare beneficiaries and patient recruiters for prescriptions that were medically unnecessary.  DOJ

October 24, 2016

Life Care Centers of America Inc., the Tennessee-based operator of more than 220 skilled nursing facilities, and its owner Forrest L. Preston, agreed to pay $145 million to resolve charges that Life Care violated the False Claims Act by submitting claims to Medicare and TRICARE for rehabilitation therapy services that were not reasonable, necessary or skilled.  It is the largest settlement with a skilled nursing facility chain in DOJ’s history.  The allegations originated in a whistleblower lawsuit filed by former Life Care employees Tammie Taylor and Glenda Martin under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of $29 million from the proceeds of the government’s recovery.  Whistleblower Insider