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Page 69 of 79

June 29, 2015

John Muir Health agreed to pay $550,000 to resolve allegations it submitted false claims for Medicare reimbursement by failing to have physicians adequately supervise the delivery of radiation therapy services.  The allegations originated in a whistleblower lawsuit filed by a former John Muir Health employee under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $110,000 as her share of the government’s recovery.  DOJ

June 24, 2015

Juan Carlos Delgado and Nereyda Infante, husband and wife owners of an Orlando health care clinic pleaded guilty to engaging in a $2.5 million health care fraud scheme.  They owned and operated several health care clinics under variations of the name Prestige Medical and from February 2012 to September 2014 they fraudulently billed Medicare on behalf of the Prestige clinics for services that never were administered.  DOJ

June 18, 2015

Edward Berman, a physician with a practice in Ridgefield, Connecticut, agreed to pay $218,633 to resolve allegations he violated the False Claims Act by submitting claims to Medicare for skilled nursing facility services that were not performed in accordance with Medicare requirements.  Specifically, the government alleges that Berman “upcoded” certain services, submitting claims to Medicare by using a higher-paying billing code when services with lower-paying billing codes were actually provided.  DOJ

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

June 16, 2015

Jacksonville, Florida-based home health company Advanced Homecare, Inc.agreed to pay $1,293,169 to settle charges it violated the False Claims Act by billing the government for millions of dollars of medically unnecessary services.  According to the government, Advanced Homecare accepted and treated patients who were not actually homebound and did not have a valid physician certification of home health need, as required by Medicare.  The allegations first arose in a whistleblower lawsuit filed by Advanced Homecare former employee Marsha Yandell under the qui tam provisions of the False Claims Act.  Ms. Yandell will receive a whistleblower award of more than $200,000.  DOJ

June 9, 2015

Earnest Gibson III, the former president of Riverside General Hospital, Earnest Gibson IV, the operator of Devotions Care Solutions, a Riverside satellite psychiatric facility, and Regina Askew, the owner of Safe and Sound group home, were sentenced to 45 years, 20 years and 12 years in prison, respectively, for their roles in a $158 million Medicare fraud scheme.  They were also ordered to pay restitution in the amount of $46,753,180, $7,518,480 and $46,255,893 respectively.  According to the evidence, the defendants had patients sit around the facility watching movies while they received no treatment, ultimately billing Medicare more than $158 million for care that was never provided.  DOJ

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

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

May 28, 2015

Garden State Cardiovascular Specialists P.C., a New Jersey-based cardiology practice which owns and operates several facilities in New Jersey under the name NJ MedCare/NJ Heart, agreed to pay more than $3.6 million to resolve allegations the company and its principals, Dr. Jasjit Walia and Dr. Preet Randhawa, submitted claims to Medicare for various cardiology diagnostic tests and procedures, including stress tests, cardiac catheterizations and external counterpulsation, which were not medically necessary. The allegations were first raised in a whistleblower lawsuit filed by Cheryl Mazurek under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of more than $648,000.  DOJ

May 27, 2015

Durable medical equipment suppliers Orbit Medical Inc. and its partial successor, Rehab Medical Inc., agreed to pay $7.5 million to settle False Claims Act charges that Orbit submitted false claims to federal health care programs for power wheelchairs and accessories.  According to the government, Orbit sales representatives knowingly altered physician prescriptions and supporting documentation to get Orbit’s power wheelchair and accessory claims paid by Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency.  The allegations were first raised in a whistleblower lawsuit filed by former Orbit employees Dustin Clyde and Tyler Jackson under the qui tam provisions of the False Claims Act.  They collectively will receive a whistleblower award of approximately $1.5 million.  Whistleblower Insider
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