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Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Posted 09/13/19

Philip Esformes, 50, of Miami Beach, Florida, was sentenced to 20 years in prison for his role in a decades-long billion-dollar scheme to submit fraudulent claims to Medicare and Medicaid both for services deemed medically unnecessary and services that were medically necessary but that he did not provide. Esformes personally pocketed $37 million from this scheme to fund his lavish lifestyle, while leaving elderly...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, SNF,

Catch of the Week – Mallinckrodt Pays for Kickbacks on Acthar; Investigation into Copayment Subsidies Continues

Posted 09/6/19

This week, the Department of Justice announced that pharmaceutical company Mallinckrodt ARD LLC had agreed to pay over $15 million to resolve allegations that it paid illegal kickbacks to physicians to induce them to prescribe Acthar.

AKS Allegations

Two whistleblower lawsuits brought under the False Claims Act against Mallinckrodt alleged that from 2009 to 2013, the pharma company, then known as Questcor,...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Pharma Fraud, Whistleblower Eligibility, Whistleblower Rewards,

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted 07/26/19

Laboratory sample vial lying on procedure coding form

Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states. CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...

Tagged in: Anti-Kickback and Stark, Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted 07/12/19

Pill container spilled over with pills fallen out.

On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

Tagged in: Anti-Kickback and Stark, FDA Fraud, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Provider Fraud,

United States Intervenes in Home Health Care Fraud Case

Posted 05/30/19

Doctor Hand Taking Money from Patient's Hand

Last week, the United States intervened in a lawsuit brought against Florida-based Doctor’s Choice Home Care and its two owners. The Department of Justice alleged that the company bribed doctors to refer patients in violation of the federal Anti-Kickback Statute and Stark Law. Both laws prohibit medical providers from paying or receiving kickbacks in connection with government-funded health care...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Decision, Home Health and Hospice, Whistleblower Case, Whistleblower Eligibility,

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Posted 05/10/19

Handcuffed business-leader walking through jail.

In a shocking first, a federal jury has convicted an opioid-company CEO and other top executives of a criminal racketeering conspiracy. Insys founder and chairman John Kapoor and four other executives bribed doctors to overprescribe a highly addictive fentanyl painkiller, and ran a phony call-center to defraud insurance companies into paying for the expensive drug. Although the company itself had already paid over...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Defendants, Dosage Fraud, Healthcare Fraud, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week,

Catch of the Week — Pharmaceutical Company Allegedly Bribed Doctors with Trips to the Kentucky Derby

Posted 05/8/19

Cartoon of Sick Monkey and Horse Doctor Doing Check-Up

A recent settlement between the Department of Justice and US WorldMeds (“USWM”), show how creative, and how luxurious, kickbacks allegedly paid to physicians can be. The company, a pharmaceutical manufacturer, agreed to pay $17.5M to resolve claims that it violated the False Claims Act by paying kickbacks to patients and doctors by boosting sales of two of their drugs, Apokyn (a drug used to treat Parkinson’s...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Importance of Whistleblowers, Whistleblower Case, Whistleblower Rewards,

DOJ Announces Criminal Indictments in International Health Care Fraud Scheme that Caused $1.2 Billion in Medicare Losses

Posted 04/12/19

The U.S. Department of Justice announced this week that it had issued criminal indictments against two dozen individuals in one of the largest health care fraud schemes in U.S. history. The indictments target an alleged scheme involving the payment of illegal kickbacks and bribes by durable medical equipment (DME) companies in exchange for the referral of Medicare beneficiaries by doctors working with fraudulent...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medical Devices and DME,

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

Posted 03/28/19

MedStar Health, a health system in Maryland and Washington, DC, and two of its hospitals have settled allegations that they violated the False Claims Act by violating the Anti-Kickback Statute. The settlement is not a determination of liability. It settles specific allegations that MedStar paid kickbacks to MidAtlantic Cardiovascular Associates, a cardiology group based in Maryland, in exchange for...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Whistleblower Case,

Question of the Week — Are device manufacturer's services valuable education or unlawful kickbacks?

Posted 03/13/19

Person in scrubs and gloves holding medical device on draped table

Earlier this week, medical-device manufacturer Medtronic's Covidien business unit agreed to pay approximately $20 million to resolve kickback allegations related to the sale of its ClosureFast radiofrequency ablation catheters. ClosureFAST catheters are used in procedures to treat venous-reflux disease, whose symptoms include varicose veins. The settlement resolves claims that Covidien improperly provided doctors...

Tagged in: Anti-Kickback and Stark, Question of the Week,

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Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Catch of the Week – Mallinckrodt Pays for Kickbacks on Acthar; Investigation into Copayment Subsidies Continues

AKS Allegations

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

United States Intervenes in Home Health Care Fraud Case

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Catch of the Week — Pharmaceutical Company Allegedly Bribed Doctors with Trips to the Kentucky Derby

DOJ Announces Criminal Indictments in International Health Care Fraud Scheme that Caused $1.2 Billion in Medicare Losses

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

Question of the Week — Are device manufacturer's services valuable education or unlawful kickbacks?

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