Archive

June 26, 2015

Charlie Chi, the former president and CEO of OtisMed Corporation, was sentenced to two years in prison and to pay a $75,000 fine for intentionally distributing a medical device used in knee replacement surgery after its application for marketing clearance had been rejected by the Food and Drug Administration. In September 2014, OtisMed, now a subsidiary of Stryker Corporation, was sentenced to a criminal fine of $34.4 million and ordered to pay $5.16 million in criminal forfeiture for this conduct. In a related civil settlement, OtisMed agreed to pay approximately $41.2 million to resolve its civil liability for submitting false claims to the Medicare, TRICARE, Federal Employees Health Benefits and Medicaid programs. DOJ

Tagged in: FCA Federal, FDA Fraud, Medical Devices and DME, Off-Label and Unapproved Use, Other Government Health Programs,

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services. According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level. The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Other Government Health Programs, Upcoding,

June 5, 2015

Atlanta-based dental practice Dennis B. Jaffe D.M.D., P.C. and its principal Dennis Jaffe agreed to pay $324,327.05 to settle charges they violated the False Claims Act by fraudulently billing Medicaid for tooth extraction procedures and for fraudulently billing for services rendered by a dental assistant when Jaffe was not present in the office. According to the government, Jaffe fraudulently sought payment from Medicaid for higher and more expensive levels of service than were actually performed, a practice commonly referred to as “upcoding.” The allegations first arose in a whistleblower lawsuit filed by Michelle Smith under the qui tam provisions of the False Claims Act. DOJ

Tagged in: FCA Federal, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme. Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit. Clearview is now owned by Community Health Systems which purchased HMA in January 2014. According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute. As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act. The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act. He will receive a whistleblower award of $119,031. DOJ, GA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services. Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing. The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC. The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act. She will receive a yet-to-be determined whistleblower award. DOJ

Tagged in: FCA Federal, FCA State, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

April 15, 2015

Mehran Zamani pleaded guilty to a multimillion Medicaid fraud scheme relating to his work for Landmark Dental, Dental Group of Stamford and Dental Group of Connecticut where he served as the front for Gary Anusavice, the real owner of the businesses, who was a convicted felon, former dentist, and excluded Medicaid provider. FBI

Tagged in: Healthcare Fraud, Medicaid,

March 19, 2014

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $5,412,502 to resolve claims it violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons. The allegations arose in a whistleblower lawsuit filed by Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A., under the qui tam provisions of the False Claims Act. Dr. Montejo will receive a whistleblower award of $1,082,500. DOJ

Tagged in: Other Government Health Programs,

March 16, 2015

Los Angeles pharmacist Rouzbeh Javaherian pleaded guilty to defrauding the Medicare Part D program through his pharmacy called Emoonah Inc. (d/b/a Westaid Pharmacy and Medical Supply). Specifically, he paid illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid and he submitted fraudulent claims to Medicare Part D plan sponsors for prescriptions he did not actually fill. DOJ

Tagged in: Part D, Pharma Fraud,

February 24, 2015

Louisiana oncologist Prabhjit S. Purewal agreed to pay $550,000 to settle allegations he defrauded Medicare, Tricare and Medicaid in violation of the False Claims Act by billing for chemotherapy drugs not approved by the FDA. Dr. Purewal purchased the drugs from UK-based drug distributor Warwick Healthcare Solutions, Inc. (also known as Richard’s Pharma), which did not have a license to distribute drugs in the US. DOJ

Tagged in: FCA Federal, Off-Label and Unapproved Use, Other Government Health Programs, Pharma Fraud, Provider Fraud,

February 2, 2015

Tennessee-based Community Health Systems Professional Services Corporation and three affiliated New Mexico hospitals agreed to pay $75M to settle allegations they violated the False Claims Act by making illegal donations to county governments which were used to fund the state share of Medicaid payments to the hospitals. The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Community Health revenue manager Robert Baker. He will receive a whistleblower reward of $18,671,561 as his share of the government’s recovery. DOJ

Tagged in: FCA Federal, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

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