Archive

May 31, 2016

Newark, New Jersey-based Saint Michael’s Medical Center Inc. agreed to pay $450,000 to resolve allegations it violated the False Claims Act by falsely billing Medicare and Medicaid for medically unnecessary cardiac procedures.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act.  DOJ (DNJ)

May 26, 2016

New York announced that it has entered into a settlement agreement with Vascuscript, Inc., d/b/a Mobile Pharmacy Solutions, to resolve allegations that it billed Medicaid for prescriptions which were written by an excluded Medicaid Provider. The Attorney General’s investigation determined that from April 21, 2010, through January 25, 2013, Vascuscript, Inc. submitted and received payment on approximately 4,600 claims to Medicaid for prescriptions that were written by Dr. Mikhail Strutsovskiy. The Department of Health had previously excluded Dr. Strutsovskiy from the Medicaid program, rendering prescriptions written by him ineligible for Medicaid reimbursement. Before filling a prescription, pharmacies are required under Medicaid billing rules to first ascertain whether the prescriber’s services are eligible for reimbursement. Because Vascuscript did not do so, it filled and delivered the prescriptions written by Dr. Strutsovskiy that were not eligible for Medicaid reimbursement. NY

May 20, 2016

Hospicio La Paz, Inc. agreed to pay $2.5 million to settle charges of violating the False Claims Act in connection with approximately $1.5 million in questionable billings it submitted for payment to the Medicare Part A program.  DOJ (D.PR)

May 18, 2016

Missouri physician Randall E. Meyer pleaded guilty to (and agreed to pay roughly $75,000) violating the False Claims Act.  Meyer, a surgeon with Central Missouri Cardiology, P.C., admitted claiming the percentage of patients’ lesions and stenosis in their arteries was 70 percent or greater when it was substantially less.  The health care benefit programs would not have reimbursed claims if the programs had known Meyer was inflating the percentage of patient lesion and stenosis.  DOJ (W.D.MO)

May 6, 2016

The Trustees of the University of Pennsylvania, on behalf of its operating divisions, including the University of Pennsylvania Health System (UPHS), agreed to pay roughly $76,000 to settle charge of violating the False Claims for the alleged submission of false home health care billings to the Medicare program.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  DOJ (EDPA)

May 5, 2016

The City of New York agreed to pay $4.3 million to settle charges of violating the False Claims Act through the New York City Fire Department's receipt of reimbursements for claims for emergency ambulance services that did not meet Medicare’s medical necessity requirement.  This matter was brought to the attention of the U.S. Attorney’s Office through a voluntary disclosure by the City.  DOJ (SDNY)

April 28, 2016

California doctor Gary J. Ordog pleaded guilty to submitting more than $2.4 million in fraudulent claims to Medicare.  Ordog, who purported to be a physician specializing in toxicology, admitted submitting false claims to Medicare for purported visits with Medicare beneficiaries, when in fact those visits never actually occurred, including on dates when Ordog was out of the country.  He also admitted to billing for services provided to beneficiaries who were deceased and for services totaling more than 24 hours in one day.  DOJ

April 19, 2016

Michigan doctor Ali Elhorr pleaded guilty for his role in a $2.4 million health care fraud scheme.  Elhorr, who worked at House Calls Physicians P.L.L.C., admitted to conspiring with others, including his brother, Dr. Hicham Elhorr, to commit health care fraud by agreeing to serve as a “supervising” physician for unlicensed individuals purportedly providing in-home physician services.  The unlicensed individuals prepared medical documentation that Elhorr and other licensed physicians signed as if they had performed the visits when, in fact, Elhorr and the other licensed physicians had not treated the beneficiaries.  The visits were then billed as if performed by the licensed physicians.  DOJ

April 18, 2016

Miami physician Henry Lora was sentenced to 108 months in prison for his role in a Medicare fraud scheme that caused approximately $30 million in losses.  Lora was the medical director of Miami-area clinic Merfi Corporation and admitted that in exchange for kickbacks and bribes, he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided.  He also admitted falsifying patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Merfi owner was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ

April 18, 2016

Maryland-based Bon Secours Health System and one of its surgical oncologists, Dr. Eugene Chang, agreed to pay $400,000 to settle charges of violating the False Claims Act by billing Medicare and other federal healthcare programs for non-covered breast examinations and ultrasounds.  The allegations originated in a whistleblower lawsuit filed by a former Bon Secours practice manager and a former colleague of Dr. Chang under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of $108,000 out of the proceeds of the government’s recovery.  Whistleblower Insider