Archive

May 9, 2022

Prism Behavioral Solutions has agreed to pay $650,000 to resolve allegations of violating the federal and California False Claims Acts by billing California’s Medicaid program for services not provided to autistic children and young adults. The whistleblower in this case, Diana Mason, is a behavioral analyst employed by Prism, and will receive a $170,000 share of the settlement. USAO SDCA; CA AG

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 5, 2022

SHC Home Health Services of Florida, LLC, a/k/a Signature HomeNow paid $2.1 million for False Claims Act violations. Between 2013 and 2017, Signature HomeNow submitted false Medicare claims for home health services to patients who either were not homebound, did not require certain skilled care, did not have a valid or appropriate plan of care in place, and/or didn’t have the requisite face-to-face encounters for appropriate certification. USAO WDKY; USAO SDFL

Tagged in: FCA Federal, Home Health and Hospice, Medicare, Provider Fraud,

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 13, 2022

A number of anesthesia entities owned and operated by Care Plus Management, LLC (Care Plus), which itself is owned and operated by doctors Paul D. Weir and John R. Morgan, have agreed to pay $7.2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act. A qui tam suit by whistleblower Robert Douglas had alleged that between 2012 and 2016, Care Plus entered into illegal revenue-sharing arrangements with physicians in exchange for patient referrals. For his contributions to a successful enforcement action, Douglas will receive a $1.3 million share of the settlement. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 12, 2022

Providence Health & Services Washington has agreed to pay $22.7 million to settle allegations of submitting false claims to Medicare, Medicaid, and TRICARE. According to an unnamed whistleblower, who will receive a $4.2 million relator’s share, the hospital allegedly gave their neurosurgeons volume-based financial incentives to perform complex surgeries, thereby incentivizing two neurosurgeons to perform an excessive number of complex surgeries on inappropriate candidates without regard to medical necessity or patient safety, and ultimately causing an excessive level of complications. USAO EDWA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

March 28, 2022

A Pennsylvania-based psychiatrist and his wife have agreed to pay $3 million in the largest recovery against a single psychiatrist ever in the history of the U.S. Department of Labor – Office of Worker’s Compensation Programs (OWCP). From 2013 to 2021, Dr. Harry Doyle and his wife and sole employee, Sonya, allegedly billed OWCP for services that weren’t rendered, submitted double-billed and upcoded patient claims, and falsified patient records to reflect their false billing. As part of the settlement, they will be excluded from participating in federal healthcare programs for 25 years. USAO EDPA

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

March 22, 2022

Ten doctors in Texas and a healthcare executive have agreed to pay nearly $1.7 million to resolve allegations of violating the False Claims Act, Anti-Kickback Statute, and Stark Law. In exchange for ordering laboratory tests from Rockdale Hospital d/b/a A little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation, the doctors allegedly received thousands of dollars in kickbacks disguised as investment returns. USAO EDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

March 21, 2022

Jonathan and Daniel Markovich, two brothers who operate addiction treatment facilities in Florida, have been sentenced to over 15 years and 8 years in prison respectively after being convicted of running a $112 million fraud scheme. Through patient recruiters, the defendants paid illegal kickbacks to patients in the form of airline tickets, cash payments, and illegal drugs to entice them to visit their inpatient detox and residential facility, Second Chance Detox LLC d/b/a Compass Detox, as well as their outpatient treatment program, WAR Network LLC. The defendants then billed for therapy sessions that were not regularly provided to or attended by patients, and urine drug tests that were not medically necessary. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

February 2, 2022

New York healthcare provider The Door - A Center for Alternatives has agreed to pay $12.9 million to resolve claims that it submitted false claims for reimbursement to New York's Indigent Care Pool, which is funded by Medicaid. The Door was required to submit annual cost reports to New York reporting figures including the number of "threshold visits" to its ambulatory diagnostic and treatment center. A qui tam case initiated by two whistleblowers alleged that defendant knowingly inflated the number of threshold visits to increase payments. SDNY

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Other Government Health Programs, Provider Fraud, Whistleblower Case,

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