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March 29, 2023

A man who led a scheme to defraud New York’s Medicaid program has been sentenced to almost 8 years in prison, ordered to pay $8.5 million in restitution, and ordered to forfeit $8.5 million in ill-gotten gains.  While supervising more than a dozen others affiliated with KJ Transportation C Services Inc. (“KJ”), Julio Alvarado submitted or caused to be submitted false claims for transportation services to Medicaid beneficiaries, for which KJ was ultimately paid $20 million.  However, in many of those cases, the beneficiary was deceased or out of the country at the time of the alleged transport, or had never heard of or taken rides with KJ.  In other instances, the beneficiary received kickbacks from KJ in exchange for their Medicaid information.  USAO SDNY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid,

March 27, 2023

Laboratory Corporation of America (“Labcorp”) has agreed to pay $2.1 million to settle a lawsuit by former employee Donna Hecker-Gross, who alleged that Labcorp overbilled the Department of Defense for genetic tests performed by a third party.  Under a 2012 contract, Labcorp was to perform laboratory testing for military treatment facilities worldwide, but certain specialized tests would be performed by subcontractor GeneDx.  However, when billing the Department of Defense for tests performed by GeneDx, LabCorp allegedly overcharged for them, double or triple billed for them, or billed for them even in the absence of evidence the tests were ever performed.  For initiating a successful enforcement action, Hecker-Gross will receive a $357,000 relator’s share.  USAO MD

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

March 20, 2023

Acute care hospital Luminis Health Doctors Community Medical Center, Inc. (“DCMC”) and radiology imaging practice Diagnostic Imaging Associates, LLC (“DIA”) have agreed to pay $2 million to resolve allegations of defrauding federal healthcare programs.  Because DCMC’s outpatient cancer screening facility was not enrolled in Medicare and Medicaid and was thus not eligible for reimbursements, it entered into a written agreement with DIA whereby DIA would bill the programs for services performed by DIA as well as DCMC’s outpatient cancer screening facility, in violation of program rules and the False Claims Act.  The alleged misconduct occurred between 2010 and 2020.  USAO MD

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

March 3, 2023

Florida-based Lakeland Regional Medical Center (“LRMC”) has agreed to pay $4 million to resolve False Claims allegations of making improper non-bona fide donations to Florida’s Polk County in order to free up funds and increase the center’s reimbursements from Medicaid.  The donations involved paying off some of the county’s financial obligations to other healthcare providers, so the reimbursements that LRMC received were effectively funded by their own donations.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medicaid,

February 27, 2023

Several individuals and entities involved with the Saratoga Center for Rehabilitation and Skilled Nursing Care have agreed to pay over $7.1 million to resolve allegations of violating the False Claims Act by submitting claims for essentially worthless services.  From 2017 until the center closed in 2021, while receiving reimbursements from New York’s Medicaid program, the center’s owners and operators failed to provide adequate staffing, hot water, and clean linens, and failed to dispose of solid waste.  As a result of these failures, conditions fell below regulatory standards, and residents suffered from unnecessary errors and neglect.  NY AG; DOJ

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, SNF,

February 27, 2023

The University of Pittsburgh Medical Center (“UPMC”), University of Pittsburgh Physicians (“UPP”), and Dr. James Luketich have agreed to pay $8.5 million to settle a False Claims Act suit launched by a former UPMC surgeon, Dr. Jonathan D’Cunha.  According to the qui tam suit, which was joined by the government, Dr. Luketich regularly billed Medicare for concurrently performed complex cardiothoracic surgeries, often as many as three at a time, in violation of statutes and regulations.  The practice increased the risk of surgical complications to patients, as it meant the physician was not present for key portions of the surgeries, and patients were under anesthesia for longer than necessary.  USAO WDPA

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Whistleblower Case,

February 16, 2023

Texas-based ELPSS Career Institute LLC and its director have been ordered to pay $9 million for violating the Post-9/11 GI Bill and False Claims Act.  Under the Post-9/11 GI Bill, the school was required to operate for at least two years before enrolling students receiving benefits.  ELPSS, however, did so less than a year after applying for approval, falsely certified to its compliance with all requirements, and as a result, received more than $2.3 million in reimbursements it was not entitled to.  USAO WDTX

Tagged in: Certifications, Education Fraud, FCA Federal, Government Programs Fraud,

February 13, 2023

Spacelabs Healthcare, LLC has agreed to pay $2.5 million to settle claims of violating the False Claims Act by overcharging the Department of Veteran Affairs and Department of Defense between 2014 and 2019.  According to a qui tam suit filed by two former Spacelabs employees, Marci Gebhardt and Christopher Kelley, the company agreed to contract clauses in which they would sell patient monitoring equipment to the government at lower rates.  However, Spacelabs then failed to comply when billing the VA and Defense Logistics Agency.  For their role in bringing a successful enforcement action, Gebhardt and Kelley will share in a $437,500 reward.  DOJ

Tagged in: FCA Federal, Government Procurement Fraud, Healthcare Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

February 10, 2023

A public organization working on behalf of the City of Detroit and the Detroit Building Authority has agreed to pay the federal government $1.5 million to resolve allegations of violating the False Claims Act.  In connection with a project to demolish blighted properties in the city, the Detroit Land Bank Authority (“DLBA”) allegedly paid demolition contractors for six years’ worth of unsubstantiated backfill dirt costs using funds from the Hardest Hit Fund, which is funded by the federal Troubled Asset Relief Program.  USAO EDMI

Tagged in: FCA Federal, Government Programs Fraud,

February 7, 2023

United Energy Workers Healthcare, Corp., which provides home health services in multiple states, has paid $9 million to resolve allegations of submitting false claims to the U.S. Department of Labor on behalf of beneficiaries of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).  Multiple whistleblowers alleged that between 2013 and 2021, the defendant and related entities billed for services that were either not covered under EEOICPA program rules, not medically necessary, not provided by appropriately licensed individuals, or not provided entirely.  USAO SDOH

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Other Government Health Programs, Provider Fraud, Whistleblower Case,

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