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February 12, 2016

New Jersey Doctor Labib E. Riachi and two companies he owns, Riachi, Inc. and Center for Advanced Pelvic Surgery, agreed to pay $5.25 million to resolve allegations they violated the False Claims Act by billing Medicare and Medicaid for anorectal manometry and electromyography diagnostic tests, even though most of the tests were never performed.  The settlement also resolves charges that they submitted claims to Medicare for physical therapy services that should not have been paid because they were not performed by a qualified therapist.  DOJ (NJ)

Tagged in: Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

February 11, 2016

Compounding pharmacies WELLHealth and Topical Specialists and four physicians, Manish Bansal, Mehul Parekh, Marisol Arcila, and Syed Asad, agreed to pay approximately $10 million to resolve allegations they violated the False Claims Act by submitting false claims to TRICARE, the military’s healthcare program.  According to the government, the physicians wrote hundreds of prescriptions for pain and scar creams never used by patients and billed to the government at a cost which yielded up to 90% in profits.  Bansal is a cardiologist at Baptist Hospital; Arcila is a pain management physician at Premier Spine & Pain Center; Asad is a neurologist at Universal Neurological Care; Parekh is a general practice physician at Baptist Hospital.  DOJ (M.D.Fla)

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Other Government Health Programs, Pharma Fraud, Provider Fraud,

February 9, 2016

Miami physician Henry Lora, medical director of Miami-area clinic Merfi Corporation, pleaded guilty for his role in a Medicare fraud scheme that caused more than $20 million in losses.  Lora 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.  Lora and his co-conspirators also falsified patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Isabel Medina, the owner of Merfi, was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ

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

January 29, 2016

Amalya Cherniavsky and her husband Vladislav Tcherniavsky, the former owner and former operator of California-based durable medical equipment supply company JC Medical Supply were sentenced  for their roles in a $1.5 million Medicare fraud scheme.  They were ordered to pay $614,418 in restitution and Tcherniavsky was ordered to serve 51 months in prison.  The evidence at trial demonstrated that they paid illegal kickbacks to patient recruiters in exchange for patient referrals and paid kickbacks to physicians for fraudulent prescriptions—primarily for expensive, medically unnecessary power wheelchairs—which the defendants then used to support fraudulent bills to Medicare.  DOJ

Tagged in: Anti-Kickback and Stark, Lack of Medical Necessity, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

January 29, 2016

Florida arrested three individuals for allegedly defrauding Medicaid out of more than half a million dollars. Two more defendants are being sought by authorities for arrest. According to the investigation, Matthew, Micah and Jimmie Harrell, along with Kenneith Durden and Keith Daly, billed Medicaid for services not provided and fraudulently used a licensed mental health provider’s information without that provider’s knowledge or consent to become accepted as a Medicaid provider. Matthew Harrell and Kenneith Durden allegedly set up parallel, fraudulent business operations in Florida, Georgia and Louisiana that all engaged in similar criminal activities. The businesses operated under the names Revive Athletics Florida, Divine Consulting Services, and Durden Consulting Services of Florida. FL

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud,

January 27, 2016

New York announced that it reached an agreement with a Capital Region transportation company, Advantage Transit Group, Inc., for repayment of Medicaid funds totaling over $1 million dollars that the company was not entitled to receive. Advantage Transit Group provides, among other services, transportation for Medicaid recipients to and from appointments and submits claims for reimbursement to Medicaid. Under the settlement agreement, Advantage Transit Group acknowledged that it submitted claims for reimbursement to Medicaid for transportation services and received payment for services that were not rendered. NY

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

January 14, 2016

Nery Cowan, a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center Inc., pleaded guilty in connection with a $63 million health care fraud and money laundering scheme.  Behavioral Healthcare is a now-defunct Miami-area partial hospitalization program (PHP) that purported to provide intensive treatment for severe mental illness.  Specifically, Cowan directed the payment of kickbacks to patient brokers and others in exchange for Medicare beneficiary referrals and admitted concealing the kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida.  Cowan and her co-conspirators disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc., a sham staffing company.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Medicare, Provider Fraud,

January 12, 2016

Kentucky-based healthcare provider Kindred Healthcare, Inc. and its two RehabCare Group subsidiaries agreed to pay $125 million to resolve allegations of violating the False Claims Act by knowingly causing skilled nursing facilities to submit false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary and skilled, or that never occurred at all.  According to the government, RehabCare’s policy has been to achieve the highest Medicare reimbursement level regardless of the clinical needs of its patients, resulting in the provision of unreasonable and unnecessary services to Medicare patients, and its skilled nursing facility customers submitting inflated bills to Medicare covering those services.  The allegations originated in a whistleblower lawsuit filed by Janet Halpin, a RehabCare physical therapist and former rehabilitation manager, and Shawn Fahey, a RehabCare occupational therapist, under the qui tamprovisions of the False Claims Act.  They will receive a whistleblower award of nearly $24 million from the government proceeds of the settlement.  Whistleblower Insider

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, SNF, Whistleblower Case, Whistleblower Rewards,

January 12, 2016

Connecticut-based J&L Medical Services agreed to pay $600,000 to resolve allegations it violated the federal and state False Claims Acts.  J&L Medical is a durable medical equipment company that provides Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) devices and accessories to Medicare and Medicaid beneficiaries who have been diagnosed with obstructive sleep apnea.  According to the government, the company regularly used the services of unlicensed technicians to provide respiratory therapy services to Medicare and Medicaid beneficiaries, including setting up CPAP and BiPAP machines, fitting the patients with the masks used with those machines, and educating the patients about the use of the machines.  The allegations originated in a whistleblower lawsuit filed by John Hart, a former employee of J&L Medical and a licensed respiratory therapist, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $102,000 from the proceeds of the government’s recovery.  DOJ (CT)

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Medicaid, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

January 5, 2016

Nashville Pharmacy Services, LLC, and its majority owner Kevin Hartman, agreed to pay up to $7.8 million to settle charges they violated the False Claims Act by overbilling Medicare and TennCare for pharmacy services.  Specifically, the government claimed the Nashville-based pharmacy that specializes in dispensing HIV and AIDS-related medications automatically refilled medications without a request from the beneficiary or their physician; improperly waived TennCare and Medicare co-payments without an individualized assessment of ability to pay; improperly used pharmaceutical manufacturers’ co-payment cards to pay the co-payments of Medicare beneficiaries; billed for medications dispensed after the deaths of certain beneficiaries; and billed for medications that lacked a valid prescription.  The allegations originated in a whistleblower lawsuit filed by Marsha McCullough, a former Nashville Pharmacy order entry technician, under the qui tamprovisions of the False Claims Act.  She will receive a whistleblower award of 18 percent of the government’s recovery which could amount to $1.4 million.  Whistleblower Insider

Tagged in: Drug and DME Pricing, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

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