Archive

December 6, 2022

Centene will pay $17 million to the State of Oregon to resolve an investigation that the company, which served as a pharmacy benefit manager for the state’s Medicaid program, failed to provide certain pharmacy discounts in Oregon, resulting in inflated fees paid to Centene. OR

Tagged in: Drug and DME Pricing, FCA State, Healthcare Fraud, Medicaid, Pharma Fraud,

December 5, 2022

An opioid abuse treatment facility in New Jersey has agreed to pay $3.15 million and enter into a three-year deferred prosecution agreement to resolve criminal and civil charges relating to alleged violations of the federal Anti-Kickback Statute. Between 2009 and 2015, Camden Treatment Associates LLC (CTA) allegedly received kickbacks from a related company in exchange for exclusive orders of CTA’s methadone mixing services. CTA then allegedly submitted false claims to Medicaid and obstructed a Medicaid contractor’s attempt to audit those claims in 2016 by falsifying patient records. USAO NJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medicaid,

November 14, 2022

The Florida Birth-Related Neurological Injury Compensation Association and a related entity, which were created by the State of Florida to provide compensation for the medical, rehabilitative and custodial care of children who suffered certain categories of birth-related neurological injuries, will pay $51 million to resolve a whistleblower’s qui tam lawsuit, pursued on a non-intervened basis, alleging that they fraudulently caused NICA participants to submit their healthcare claims to Medicaid rather than NICA, in violation of Medicaid’s status as the payer of last resort under federal law. The relators, Veronica Arven and the estate of Theodore Arven III, will receive $12,750,000 as their share of the recovery. DOJ

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

November 3, 2022

Titan Medical Compliance, LLC, and its chiropractor owner Timothy Warren, have been ordered to pay over $15 million to resolve claims that they falsely marketed auricular electro-acupuncture devices as FDA-approved and Medicare-reimbursable, when in fact they are not. The judgment against Warren and Titan is the latest in a federal investigation into the improper billing of these non-surgical devices. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Provider Fraud,

October 31, 2022

Felix Amos of Houston, TX will serve 30 months in federal prison and will pay over $21 million in restitution for his role in a Medicare fraud scheme carried out with two other co-defendants. From 2010 to 2015, Amos owned and operated home health companies Dayton Health Bridges, Access Practical Solutions, Advanced Holistic, GetUpandWalk Inc., and Guaranty Home Health Agency. Amos and his co-conspirators submitted false claims to Medicare for patients that did not need or receive services, including deceased or incarcerated persons, and for services not ordered by a physician. USAO SDTX

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Provider Fraud,

October 18, 2022

Carter Healthcare LLC, affiliates CHC Holdings and Carter-Florida, president Stanley Carter, and Chief Operations Officer Bradley Carter have agreed to pay $23 million and $7.2 million to settle two whistleblower cases alleging violations of the False Claims Act. The first case, filed in the Western District of Oklahoma, alleged that the Oklahoma-based home health company paid illegal kickbacks to physicians under the guise of medical directorships in order to induce referrals. The second case, filed in the Southern District of Florida by former therapists Sharon Mahaffey and Mark Brimer, alleged that Carter Healthcare billed Medicare for medically unnecessary therapy and upcoded patient diagnoses for higher reimbursements. As part of the settlements, defendants Stanley and Bradley Carter have agreed to be excluded from participating in government healthcare programs for 5 years, and whistleblowers Mahaffey and Brimer will split a $1.3 million relator’s share. USAO WDOK; USAO SDFL

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

October 17, 2022

Sutter Health has agreed to pay more than $13 million to settle claims of billing Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program for quantitative urine testing that were in fact performed by third-party labs. The company has already paid more than $6.5 million and is due to pay the remaining $6.5 million in the next 30 days. USAO NDCA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicaid, Medicare, Other Government Health Programs,

October 12, 2022

Four pharmacies have agreed to pay over $6.8 million to settle a qui tam suit that alleged they defrauded TRICARE and the Federal Employees Health Benefits Program, in violation of the False Claims Act. According to a former accountant for one of the pharmacies, DermaTran Health Solutions, LLC; Pharmacy Insurance Administrators, LLC; Legends Pharmacy; TriadRx; and Lake Side Pharmacy created a program to waive mandatory copays for beneficiaries of federal health insurers, overcharged the government for compounded pain creams, and traded out-of-network prescriptions with other pharmacies, which constituted a kickback. USAO NDGA

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud,

October 6, 2022

A man in Missouri who was convicted of committing healthcare fraud through various durable medical equipment companies has been sentenced to 3 years in prison and ordered to repay $7.5 million. Jamie McCoy, who owned or operated AE Wellness LLC, Summit Medical Supply, Patriot Medical Supply, and DME Device Co., had worked in conjunction with marketing firms and a telemedicine doctor to cause fraudulent claims derived from illegal kickbacks to be submitted to Medicare and TRICARE. After the scheme was discovered and McCoy and AE Wellness were suspended from further participation, two of McCoy’s associates opened the other companies to continue the fraud, while concealing McCoy’s role in the operation. USAO EDMO

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare, Other Government Health Programs,

October 3, 2022

South Carolina-based Radeas, LLC has agreed to pay $3.6 million to settle allegations of submitting false claims to North Carolina’s Medicaid program. Radeas had allegedly billed Medicaid for simultaneously-performed presumptive and definitive urine drug tests, in violation of Medicaid policy and standard practice to run definitive tests after presumptive tests come back positive. NC AG

Tagged in: FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid,

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