Archive

April 18, 2016

Georgia dermatologists Margaret Kopchick and Russell Burken and their practice group, Toccoa Clinic Medical Associates, agreed collectively to pay $1.9 million to settle claims that they violated the False Claims Act by billing Medicare for evaluation and management (E&M) services that were not permitted by Medicare rules.  According to the government, Drs. Burken and Kopchick’s improperly billed for E&M services along with procedures where no significant and separately identifiable service was performed, and upcoded E&M services to higher levels than were appropriate, leading to overpayments by Medicare.  DOJ (NDGA)

April 14, 2016

Boston Medical Center (BMC) and two of its physician practice organizations agreed to pay $1.1 million to resolve allegations they violated the False Claims Act by improperly billing Medicare and Medicaid.  Specifically, the government charged that (1) BMC billed Medicare for more units of Rituxan, an expensive cancer drug, than BMC actually infused in its patients; (2) BMC billed Medicare and Medicaid for services at its pre-surgical treatment center even though the global fee for the subsequent surgeries covered those same treatments; and (3) BMC submitted claims to Medicare for outpatient podiatry services where the clinical documentation did not support the reasonableness and necessity of the services.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by BMC’s former Chief Compliance Officer, Kathleen Heffernan.  She will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (DMA)

April 13, 2016

Florida Pain Medicine Associates, Inc. and its owners, Drs. Bart Gatz, Alexis Renta, and Albert Rodriguez, agreed to pay $1.1 million to resolve allegations they violated the False Claims Act by billing Medicare for medically unnecessary nerve conduction studies.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Rosa Gomez, who had worked in Florida Pain Medicine’s billing department.  She will receive a whistleblower award of $242,000 from the proceeds of the government's recovery.  DOJ (SDFL)

April 12, 2016

Cecil Alexander Kent Jr. pleaded guilty to fraud charges for his role in a scheme to defraud Medicare out of approximately $6.2 million while he acted as an unlicensed physician at a Detroit in-home physician services company.  Kent admitted that while he was employed at B&M Visiting Doctors PLC and while he was unlicensed, he saw patients and falsified related patient records, including medical documents and billing documents, all under the name of a licensed medical doctor.  He admitted that among those documents falsified were prescriptions for controlled substances.  DOJ

April 11, 2016

Tennessee-based drug urine screening company PremierTox 2.0, Inc. (previously called Nexus) agreed to pay $2.5 million to resolve allegations it violated the False Claims Act by submitting false claims when billing Medicare, TennCare and Kentucky Medicaid for drug urine screening services.  According to the government, PremierTox had a swapping arrangement under which Nexus gave below cost discounts on its urine drug screen tests to patients in Tennessee without insurance, in exchange for physicians’ referring their patients with Medicare or TennCare coverage to Nexus. The government also contended that in Tennessee Nexus submitted excessive claims to Medicare and TennCare for laboratory testing that was beyond what was medically reasonable and necessary.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by a former office manager of a pain clinic and the former CEO of PremierTox.  The office manager will receive a whistleblower award of $361,250, and the former CEO will receive a whistleblower award of $56,250.  DOJ (MDTN)

April 11, 2016

Naseem Minhas, the owner and operator of Detroit-area home health care agency TriCounty Home Care Services Inc. pleaded guilty today for his participation in a $4 million health care fraud scheme.  According to admissions made as part of his plea agreement, Minhas paid a physician and recruiters to refer Medicare beneficiaries to TriCounty and sign medical documents falsely certifying that they required home health care.  Minhas, a licensed physical therapist, also admitted that he assisted in creating fake patient files to make it appear as though the patients needed and received services that were unnecessary or not provided.  DOJ

March 25, 2016

Damian Mayol, the president of Miami-based transportation company Transportation Services Providers Inc. was sentenced to 60 months in prison and to pay $26.8 million in restitution (and forfeit the same amount) for his role in a health care fraud scheme involving three mental health centers that resulted in the submission of approximately $70 million in false Medicare claims.  According to evidence presented at trial, Mayol and his co-conspirators used his company to coordinate the payment of illegal kickbacks to recruiters, who in return referred patients to three now-defunct community mental health centers -- R&S Community Mental Health Inc., St. Theresa Community Mental Health Center Inc. and New Day Community Mental Health Center LLC -- for costly partial hospitalization program services that were not medically necessary or not actually provided.  DOJ

March 23, 2016

Detroit-area doctor Laran Lerner was sentenced to 45 months in prison and to pay $2.8 million in restitution for his role in a $5.7 million Medicare fraud scheme in which he prescribed medically unnecessary controlled substances and billed for office visits and diagnostic testing that never took place.  DOJ

March 21, 2016

Florida audiologist Terri L. Schneider was sentenced to 94 months in prison and to pay $2.5 million in restitution for her role in a multimillion-dollar health care fraud and money laundering scheme. According to evidence presented at trial, Schneider and her co-conspirators used three purported medical clinics in Florida -- Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists -- to submit approximately $12.3 million in false Medicare claims seeking reimbursement for radiology, audiology, cardiology and neurology services.  The evidence showed that Schneider and her co-conspirators used forged and falsified documents in the Medicare enrollment process for the medical clinics that they operated under false pretenses, and billed Medicare for services that had not been rendered by physicians.  They also paid illegal kickbacks in exchange for access to Medicare patients and Medicare patient information used in the fraud scheme.  DOJ

March 18, 2016

A federal jury in New Orleans convicted Elaine Davis and Dr. Pramela Ganji for their roles in a $34 million Medicare fraud scheme.  The jury found that Davis, who owned Christian Home Health Care Inc., together with Ganji caused the healthcare company to bill Medicare for home health care services that were not needed and/or not actually provided.  Davis paid employees to recruit new patients and then sent their Medicare information to doctors, including Ganji, to obtain their signatures to certify that the patients qualified to receive home health care services, which trial evidence showed they did not qualify for or need.  DOJ