Archive

September 21, 2016

Michigan doctor Hussein Awada agreed to pay $200,000 to resolve charges he violated the False Claims Act by writing prescriptions for oxycodone and other controlled medications and billing for medical services without medical justification.  According to the government, Awada conspired with patient “marketers” to write prescriptions for tens of thousands of dosages of oxycodone and other controlled medications for no medical purpose and then used the patient data to submit bills to Medicare for services that were either never performed or were medically unjustified.  Awada also caused these same patients to receive medically unnecessary monthly x-rays, and other invasive tests, to help conceal his fraud.  Awada previously pled guilty to these charges and was sentenced to 84 months in prison and pay $2.3 million in restitution.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Heather Henson, who worked as a receptionist for Awada at his medical practice.  She will receive a whistleblower award of $36,000.  DOJ (EDMI)

September 19, 2016

North American Health Care Inc., a California-based operator of dozens of skilled nursing facilities (along with its Chairman John Sorenson and Senior Vice President of Reimbursement Analysis Margaret Gelvezon) agreed to pay $30 million to resolve charges they violated the False Claims Act by billing for medically unnecessary rehabilitation therapy services.  Whistleblower Insider

September 22, 2016

A federal jury in Los Angeles convicted the owner of a medical clinic for his role in a health care fraud scheme and for filing false income tax returns. Evidence introduced at trial showed that Michael Huynh, 66, the office manager and part-owner of a medical clinic, provided false prescriptions to a pharmacist and co-conspirator, Farhad N. Dany Sharim, who submitted false claims to insurance companies for drugs that were never dispensed. Once Sharim received payments from the insurance companies, he paid Huynh for the false prescriptions. Trial evidence showed that between January 2004 and November 2009, Huynh received 82 checks from Sharim totaling over $1.1 million. Evidence at trial also demonstrated that Huynh filed false federal tax returns for tax years 2007 through 2011 that underreported the medical clinic’s gross receipts and sales on the corporate tax returns and total income on the individual tax returns. Trial evidence showed underreported income of over $1.6 million. DOJ

September 9, 2016

Los Angeles nursing home Westlake Convalescent Hospital and two physicians who worked there, Dr. Jasvant Modi and his wife Dr. Meera Modi, agreed to pay $3,563,140 to resolve charges they violated the False Claims Act by participating in a scheme to improperly transfer patients recruited from the “Skid Row” district to a hospital for medically unnecessary services, and then transfer the patients from the hospital to the nursing home for medically unnecessary stays.  According to the government, Westlake paid illegal kickbacks to a “care consortium” on Skid Row in exchange for patient referrals to Westlake.  Jasvant Modi allegedly readmitted patients from Westlake to the now-closed Temple Community Hospital and then back to Westlake to extend the patients’ Medicare-covered stays at Westlake, knowing the patients did not require further services at either facility.  Meera Modi allegedly signed medical orders for non-payable services for these same patients. Westlake allegedly billed Medicare and Medi-Cal for medically unnecessary services provided to these patients.  The allegations originated in a whistleblower lawsuit brought by former Westlake employee Ricardo Gonzales under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $534,471 from the proceeds of the government's recovery.  DOJ (CDCA)

September 7, 2016

Clinical psychologists Beverly Stubblefield and John Teal pleaded guilty for their involvement in a fraudulent psychological testing scheme that preyed upon Medicare recipients living in nursing homes throughout the Southeastern United States.  Stubblefield and Teal practiced as clinical psychologists at Nursing Home Psychological Services, Inc. and Psychological Care Services, Inc. and they admitted their companies billed Medicare for psychological tests to nursing home residents throughout Mississippi, Louisiana, Florida and Alabama which were not medically necessary or not provided at all.  They further admitted they repeatedly tested the same nursing home residents even though some were incapacitated and could not meaningfully participate in testing.  DOJ

August 31, 2016

Clear Vue Eye Center and its owner, Dr. Monique Barbour, agreed to pay $1 million to resolve allegations that they violated the False Claims Act by overbilling Medicare for patient visits at nursing homes and assisted living facilities, and for billing for procedures purportedly performed while Dr. Barbour was out of the country.  According to the government, Dr. Barbour billed excessively for patient visits, billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period.  Records reviews show that many of the procedures billed were medically unnecessary with little patient benefit and that Dr. Barbour billed procedures at the most profitable rates regardless of the procedure’s proper billing code.  The allegations originated in a whistleblower lawsuit brought by former Clear Vue employee Lori Moore under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $200,000 from the proceeds of the government's recovery.  DOJ (SDFL)

August 24, 2016

New York hospitals Beth Israel Medical Center (d/b/a Mount Sinai Beth Israel), St. Luke’s-Roosevelt Hospital Center (d/b/a Mount Sinai St. Luke’s) and Mount Sinai Roosevelt, and Continuum Health Partners, agreed to pay $2,950,000 to settle charges that they violated the federal and New York False Claims Act by willfully delaying repayment of over $800,000 in Medicaid overpayments that resulted from improper claims submitted because of a software error.  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 award from the proceeds of the government's recovery.  DOJ (SDNY)

August 17, 2016

Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital and affiliated entities including a related pain clinic, Lehigh Valley Pain Management, agreed to pay $690,441 to resolve allegations they violated the False Claims Act by submitting false health care billings for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising.  The allegations originated in whistleblower lawsuit filed Margaret Reynard under the qui tam provisions of the False Claims Act.  Ms. Reynard will receive a whistleblower award of roughly $124,000 from the proceeds of the government's recovery.  DOJ (EDPA)

August 17, 2016

Florida urologist Robert A. Scappa agreed to pay $250,000 to resolve allegations that he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary.  During the relevant time period, Scappa was a urologist practicing as part of Scappa Urology, which was a division of 21st Century Oncology, LLC., a nationwide provider of integrated cancer care services.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former medical assistant who worked for Dr. David Spellberg of Naples Urology Associates, which was also a division of 21st Century Oncology.  The whistleblower will receive an award of $37,500 from the government's recovery.  This amount is in addition to a $3.2 million share she will receive as the result of the $19.75 million settlement previously reached with 21st Century Oncology.  DOJ (MDFL)

August 24, 2016

New York and the Justice Department announced that three hospitals in the Mount Sinai Health System are paying a total of $2.95 million to resolve allegations that the hospitals knowingly retained over $844,000 in overpayments made by Medicaid in violation of the federal and New York False Claims Acts. Knowing retention of an overpayment from the government for more than sixty days is known as a “reverse false claim” and is a violation of both federal and state false claim acts. The entities involved include Mount Sinai Beth Israel (“Beth Israel”) (formerly Beth Israel Medical Center), Mount Sinai St. Luke’s (“St. Luke’s”) (formerly St. Luke’s Hospital) and Mount Sinai Roosevelt (“Roosevelt”) (formerly Roosevelt Hospital) (together, the “Hospitals”) – and the Hospitals’ former partnership group, Continuum Health Partners, Inc. (“Continuum,” and together with the Hospitals, “Defendants”). As part of the settlements, Defendants admitted that, beginning in 2009 due to a software compatibility issue, a coding error caused Defendants to submit claims for payment above and beyond what they had received from the managed care organization, and that Medicaid paid these claims as a secondary payor. In September 2010, the New York Office of the State Comptroller brought to Continuum’s attention a small number of these claims, and Defendants admitted that in late 2010 they were made aware of the coding error. NY