Archive

June 2, 2022

Middle Georgia Family Rehab (MGFR) has been ordered to pay $9.6 million in damages after a judge for the Middle District of Georgia found the facility had fraudulently billed TRICARE and Medicaid. In an April order granting partial summary judgment, the Court determined that approximately 800 claims submitted to federal healthcare programs were billed under therapists who were not employed at MGFR at the time of alleged service. USAO MDGA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medical Billing Fraud, Other Government Health Programs,

June 1, 2022

Caris Life Sciences, Inc. will pay $2.9 million to resolve claims that it falsely billed Medicare for laboratory tests to detect the activity of certain genes within a tumor that predicted the risk of recurrence by fraudulently circumventing Medicare’s 14-day rule, which, during the relevant time period, prohibited laboratories from separately billing Medicare for tests performed on specimens if a physician ordered the test within 14 days of the patient’s discharge from a hospital stay. By submitting separate claims for the laboratory tests, Medicare paid twice for the same service, first to the hospital as part of the hospital’s lump-sum DRG payment, and in a direct payment to Caris. Caris allegedly discouraged providers from ordering testing within 14 days of discharge, or canceled and re-submitted orders to avoid the 14 day window. The settlement covers two separate whistleblower actions. USAO EDNY

Tagged in: Anonymity, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case,

May 19, 2022

Healthcare testing company VirtuOx, Inc. agreed to pay $3.15 million to resolve claims brought in an action initiated by a whistleblower alleging that falsely billed Medicare for pulse oximetry testing. VirtuOx allegedly reported San Francisco as the location for overnight pulse oximetry testing when, in fact, no services were performed at that location, but that location resulted in a higher Medicare reimbursement. In addition, VirtuOx allegedly billed Medicare for both oxygen “spot checks” and overnight pulse oximetry testing, when only the overnight testing was performed. The whistleblower, Amber Watt, will receive an award of $630,000. USAO SD FL

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

May 18, 2022

Pat Truglia will spend 120 months in prison, forfeit over $9.4 million, and will pay restitution of $33.7 million for conspiring to defraud Medicare, TRICARE, and CHAMPVA, among others, of approximately $50 million through their fraudulent billing scheme. The scheme involved offering, paying, soliciting, and receiving kickback for durable medical equipment—in this case, braces. Truglia and his conspirators obtained DME orders for Medicare and other federal healthcare program beneficiaries by running multiple call centers, which paid kickbacks and bribes to telemedicine companies, who then paid doctors to write medically unnecessary orders. The orders were filled by Truglia’s companies, who then fraudulently billed the healthcare programs. USAO NJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare, Other Government Health Programs, Provider Fraud,

May 16, 2022

Oklahoma Heart Hospital South, LLC paid over $1.1 million to settle alleged violations of the False Claims Act. An OHHS internal review and audit exposed Medicare billing irregularities related to their Intensive Cardiac Rehabilitation services, which they self-disclosed to the government. The US government’s follow-up investigation, with which OHHS cooperated, revealed that for a 6-year period—from 2013 to 2019—OHHS physicians failed to complete and update patients’ individualized treatment plans for care that lasted longer than 30 days. The settlement is not an admission of OHHS’ liability, and the government did not concede any of its claims. WDOK USAO

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Provider Fraud,

April 29, 2022

Eargo Inc., which sells direct-to-consumer hearing aid devices to customers nationwide, has agreed to pay $34.37 million to resolve allegations of defrauding the Federal Employees Health Benefits Program (FEHBP) over a four-year period. Eargo allegedly submitted or caused to be submitted claims that contained unsupported diagnosis codes, even though an internal review of its billing and coding practices should have detected the error. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Other Government Health Programs,

April 28, 2022

Donald Woo Lee, a California-based doctor who recruited Medicare beneficiaries to his clinics, falsely diagnosed them and provided them with medically unnecessary procedures, and then submitted upcoded bills for those procedures to Medicare, has been sentenced to nearly 8 years in prison after being found guilty of seven counts of healthcare fraud. In addition to submitting approximately $12 million in false claims to Medicare, for which he received $4.5 million in reimbursement, Lee also repackaged and reused single-use catheters on his patients. DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicare, Provider Fraud, Upcoding,

April 27, 2022

Dr. Josef Schenker and his urgent care facilities, Josef Schenker, M.D., P.C., and Care Partners Medical Management, LLC will pay $564,217.70 for violations of the False Claims Act, by submitting up-coded claims to Medicare related to administration of the COVID-19 vaccine. Schenker and the two facilities provided higher-level CPT codes for services not actually provided, charging, e.g., for an office visit or exam when the patient only actually received a vaccine or a COVID test. EDNY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Pharma Fraud, Provider Fraud, Upcoding,

April 26, 2022

A former pharmacist in Mississippi named Mitchell Barrett has been sentenced to 10 years in prison and ordered to pay restitution as well as forfeit all assets stemming from a $180 million healthcare fraud scheme against TRICARE and other health benefit programs. Barrett had adjusted prescription formulas to ensure the highest possible reimbursement, solicited recruiters to procure prescriptions for expensive compounded drugs, paid those recruiters a commission based on reimbursements from TRICARE, routinely waived copayments required to be paid by TRICARE beneficiaries, and took steps to disguise the waived payments. DOJ

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

April 21, 2022

Susan H. Poon, 57, will spend 70 months in federal prison, and will pay nearly $1.4 million in restitution for a scheme spanning over 3 years, and which resulted in approximately $2.2 million in fraudulent billings. Poon submitted prescriptions both with PII obtained at health fairs held by Costco and UPS, and by soliciting information from actual patients about their dependents—dependents whom Poon never saw or treated. Poon used the stolen PII to submit fraudulent durable medical equipment prescriptions to a DME manufacturer, who then unknowingly submitted false claims for reimbursement to a health insurer. In addition to the prison sentence and the owed restitution, Poon’s chiropractic license was revoked in 2019. USAO CDCA

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Pharma Fraud,

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