Archive

December 23, 2015

Aria Health Systems, Inc. agreed to pay more than $3 million to settle two False Claims Act matters which Aria self-disclosed.  Aria agreed to pay $564,700 to resolve claims that a cardiologist performed unnecessary invasive procedures at their Torresdale Campus between October 2012 and April 2013.  Aria also agreed to pay $2.5 million to resolve claims of compensation to physicians that were in excess of fair market value and in violation of the Stark Act. DOJ (EDPA)

December 18, 2015

Ohio cardiologist Dr. Harold Persaud, with hospital privileges at Fairview Hospital, St. John’s Medical Center and Southwest General Hospital, was sentenced to 20 years in prison for performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $29 million.  DOJ

December 18, 2015

21st Century Oncology, a Florida-based provider of integrated cancer care services, agreed to pay $19.75 million to resolve allegations it violated the False Claims Act by billing federal health care programs for laboratory tests that were not medically necessary.  The tests involved were fluorescence in situ hybridization (or “FISH”) tests which are laboratory tests performed on urine that can detect genetic abnormalities associated with bladder cancer.  The government alleged that 21st Century submitted claims for unnecessary FISH tests that were ordered by four of its urologists, Dr. Meir Daller, Dr. Steven Paletsky, Dr. David Spellberg and Dr. Robert Scappa.  The government further alleged the company encouraged these physicians to order unnecessary FISH tests by offering bonuses that were based in part on the number of tests referred to 21st Century’s laboratory.  The allegations first arose in a whistleblower lawsuit filed by a former 21st Century medical assistant under the qui tam provisions of the False Claims Act.  The whistleblower will receive a whistleblower award of $3.2 million from the proceeds of the government’s recovery.  DOJ

December 18, 2015

Maryland-based splint supplier Dynasplint Systems Inc., and its founder and president, George Hepburn, agreed to pay roughly $10.3 million to resolve allegations they violated the False Claims Act by improperly billing Medicare for splints provided to patients in skilled nursing facilities.  According to the government, to circumvent Medicare rules which provide for bundled payment to these facilities that cover all of a patient’s needs, Hepburn and Dynasplint mispresented that patients were in their homes or other places that were not skilled nursing facilities.  The allegations first arose in a whistleblower lawsuit filed by former Dynasplint sales executive Meredith Deane under the qui tam provisions of the False Claims Act.  Ms. Deane will receive a whistleblower award of roughly $2 million from the proceeds of the government’s recovery.  DOJ

December 18, 2015

Iowa Hospice, LLC agreed to pay roughly $1.1 million to settle charges it violated the False Claims Act by submitting false bills to Medicare for hospice services. The Medicare hospice benefit is only available to patients who elect palliative care for a terminal illness and who have a life expectancy of six months or less.  The government alleged that Iowa Hospice knowingly submitted false claims to the government for payment of these services for patients that did not have such a medical prognosis.  DOJ (N.D. OH)

December 16, 2015

Amer Ehsan, the owner and operator of Detroit-area home health care agency Advance Home Health Care Services Inc., was sentenced to 80 months in prison for conspiring with physicians, physical therapists and patient recruiters to bill Medicare for unnecessary home health care and therapy services and paying kickbacks to physicians for referrals.  Ehsan also admitted that he owned and controlled Michigan Rehab and Management Services LLC, which he used to sell information about Medicare beneficiaries and corresponding fictitious patient files to other Detroit-area home health care agencies.  DOJ

December 16, 2015

Louisiana doctors Barbara Smith and Roy Berkowitz and registered nurse Beverley Breaux were sentenced to 80 months, 64 months and 50 months in prison, and to pay $9,484,939, $4,952,816 and $2,057,179 in restitution, respectively, for their roles at the center of a $50 million health care fraud scheme.  Specifically, Smith and Berkowitz falsely certified that thousands of Medicare recipients were homebound and required nursing or therapy services to be provided in their homes, and Breaux falsely certified that these patients were homebound and falsely claimed to have treated patients she had not seen.  DOJ

December 7, 2015

The former owner, operator and managers of Southern California ambulance company ProMed Medical Transportation were sentenced to prison for their role in a fraud scheme that resulted in more than $1.5 million in fraudulent claims to Medicare.  Yaroslav Proshak (aka Steven Proshak) was sentenced to serve 108 months in prison.  On December 2, Emilia Zverev and Sharetta Michelle Wallace were sentenced to serve 36 and 24 months, respectively.  In addition, Zverev and Wallace were ordered to pay restitution jointly and severally with Proshak in the amount of $804,755.  The evidence at trial showed that the defendants conspired to bill Medicare for ambulance transportation services for individuals that did not need such services.  The defendants also instructed ProMed EMTs to conceal the patients’ true medical conditions by altering paperwork and creating fraudulent documents to justify the services.  DOJ

December 1, 2015

Wisconsin-based Pharmasan Labs, Inc., its related billing company NeuroScience, Inc. and their founders, Gottfried and Mieke Kellermann, agreed to pay $8.5 million to resolve charges they violated the False Claims Act by (i) submitting false information for laboratory services, and (ii) violating Medicare rules for services referred by non-physician practitioners.  According to the government, and as admitted by Pharmasan under the settlement, Pharmasan falsely billed Medicare for ineligible food sensitivity testing; knew Medicare prohibited payment for such testing; and submitted false information to Medicare to disguise the type of test it was performing so Medicare would cover it.  Pharmasan also admitted violating Medicare billing rules which bar payment for lab services referred by non-physicians.  The government investigation leading to the settlement originated from a whistleblower action filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a whistleblower award of roughly $1.1 million from the government’s recovery.  Whistleblower Insider

November 24, 2015

The former CFO of Long Beach, California-based Pacific Hospital, two orthopedic surgeons and two others have been charged in long-running health care fraud schemes that illegally referred thousands of patients for spinal surgeries and generated nearly $600 million in fraudulent billings.  The wide-ranging kickback scheme, which involved dozens of surgeons, orthopedic specialists, chiropractors, marketers and other medical professionals, involved improper referrals to Pacific Hospital and Hawaiian Hospital.  The most recent targets of the government’s investigation, all of whom have agreed to plead guilty, include: former Pacific Hospital CFO James L. Canedo; orthopedic surgeons Philip Sobol and Mitchell Cohen; chiropractor Alan Ivar; and health care marketer Paul Richard Randall, previously affiliated with Pacific Hospital and Tri-City Regional Medical Center in Hawaiian Gardens.  Under the terms of their plea agreements, Sobol faces a federal prison term of up to 10 years; Canedo, Ivar and Randall face up to five years in prison; and Cohen faces up to three years in prison.  All of them will be required to pay restitution to the victims of the scheme, which in Canedo’s case will be at least $20 million.  Whistleblower Insider