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June 11, 2015

Louisiana announced that its Medicaid program will receive over $5 million as a result of a settlement between specialty pharmacy company Accredo Health Group, Inc. and 40 states and the federal government, resolving allegations that Accredo engaged in a scheme with drugmaker Novartis to boost sales of the drug Exjade, which is used to treat chronic iron overload due to blood transfusions. Accredo is accused of improperly directing nurses to contact Medicaid beneficiaries to encourage continued use of Exjade. Accredo’s goal in the scheme was to earn higher sales revenue, additional dispensing fees and more rebates from Novartis. The nurses were directed to discuss Exjade’s common side effects, but not its less common but more severe possible side effects such as kidney or liver problems. LA

Tagged in: FCA State, Medicaid, Pharma Fraud,

May 6, 2015

New York Attorney General Eric T. Schneiderman announced that Carewell Ambulette, Inc. and its owner, Kurien Palliankal have pleaded guilty to stealing more than $200,000 from the New York Medicaid program. Palliankal will be sentenced to six months in jail, followed by five years of probation, and will also be required to pay full restitution to Medicaid. Carewell will be fined $10,000. From July 2006 through March 2010, Palliankal and Carewell defrauded the Medicaid system by doctoring the request forms received from the medical providers. These forms authorized taxi service, but Palliankal changed the forms to appear as though they authorized the more expensive ambulette service, which Medicaid pays at a rate four times higher than taxi service. NY

Tagged in: Healthcare Fraud, Medicaid, Upcoding,

April 28, 2015

Life Focus Center of Charlestown, Inc., a former nonprofit that provided day habilitation services to individuals with developmental disabilities, agreed to pay more than $94,000 to settle claims it violated the Massachusetts False Claims Act by billing the state’s Medicaid program (MassHealth) for services not provided. MA

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

April 23, 2015

Grady Health System agreed to pay $2,950,000 to settle claims it inaccurately coded claims for neo-natal intensive care unit patients, resulting in alleged damages to the Georgia Medicaid program. GA

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

April 16, 2015

Georgia doctor Zheng Xiang Wang and the Wang Eye Clinic, P.C. agreed to pay $790,000 to settle allegations they billed Georgia Medicaid for medically unnecessary ophthalmology procedures. GA

Tagged in: Lack of Medical Necessity, Medicaid, Provider Fraud,

April 13, 2015

Hallmark Health Systems agreed to pay $1.75 million to settle allegations it improperly billed the Massachusetts Medicaid Program (MassHealth) for certain inpatient admissions at its hospitals, resulting in overpayments by MassHealth. The settlement alleges that from March 2008 to December 2013, Hallmark used a specific default code that classified MassHealth patients as having received short-stay inpatient services, when an observation or outpatient level of care would have been more appropriate. MA

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

April 7, 2015

Dr. Punyamurtula Kishore along with his company Preventive Medicine Associates, Inc. pleaded guilty for running a Medicaid fraud scheme involving millions of dollars in taxpayer funds. Kishore was sentenced to 360 days in jail and ordered to pay $9.3 million in restitution. Based on the government’s investigation, Dr. Kishore used bribes, or kickbacks, to induce sober house owners to send their residents’ urine drug screening business to his laboratories for testing. MA

Tagged in: Healthcare Fraud, Medicaid,

April 7, 2015

Texas Attorney General Ken Paxton announced New Jersey-based pharmaceutical product manufacturer Glenmark Generics Inc. USA agreed to pay $25 million to resolve the State’s investigation under the Texas Medicaid Fraud Prevention Act against Glenmark for fraudulently reporting inflated drug prices to the Medicaid program. TX

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

April 2, 2015

Medical device maker Medtronic plc and affiliated Medtronic companies,Medtronic Inc., Medtronic USA Inc., and Medtronic Sofamor Danek USA Inc., agreed to pay $4.41 million to resolve allegations they violated the False Claims Act by making false statements to the Department of Veterans Affairs and the Department of Defense regarding the country of origin of certain Medtronic products sold to the US.  Specifically, the government charged Medtronic with selling to the VA and DoD products it certified would be made in the US or other designated countries when in fact they were manufactured in China and Malaysia, which are prohibited countries under the Trade Agreements Act of 1979.  The allegations were first raised in a whistleblower lawsuit filed by three unidentified whistleblowers under the qui tam provisions of the False Claims Act. They will receive a whistleblower award of $749,700.  Whistleblower Insider

Tagged in: FCA Federal, Medical Devices and DME, Other Government Health Programs, Trade Agreements, Whistleblower Case, Whistleblower Rewards,

April 1, 2015

Keli House Community Services, Inc., a nonprofit serving New Yorkers with disabilities and their families, agreed to reimburse New York’s Medicaid program $363,643 for using unqualified individuals to provide services to Medicaid recipients who participated in the Home and Community Based Services Program offered by the New York State Office of Persons with Developmental Disabilities. NY

Tagged in: Medicaid,

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