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May 21, 2015

Mohammad Khan, the former assistant administrator of Riverside General Hospital, was sentenced to 40 years in prison and to pay restitution in the amount of $31,321,200 for his role in a $116 million Medicare fraud scheme.  He previously pled guilty to his role in the scheme.  According to admissions made in connection with his guilty plea, from January 2008 through February 2012, Khan and others at Riverside General Hospital operated a scheme to defraud Medicare by submitting claims for partial hospitalization program (PHP) services that were not medically necessary and, in some cases, never provided.  Khan also admitted he and his co-conspirators paid kickbacks to patient recruiters and to owners and operators of group care homes in exchange for which those individuals delivered ineligible Medicare beneficiaries to the hospital’s PHPs.  To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme.  DOJ

Tagged in: Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud,

May 20, 2015

Florida-based neurologist Dr. Sean Orr agreed to pay $150,000 to settle allegations he violated the False Claims Act by providing medically unnecessary services and drugs to federal health care program beneficiaries.  According to the government, from September 2009 to April 2012 Orr knowingly misdiagnosed certain patients with various neurological disorders, such as multiple sclerosis, which caused federal health care programs to be billed for medically unnecessary services and drugs.  In 2014, the government settled related allegations against Baptist Health System Inc. – Orr’s former employer and the parent company for Baptist Neurology Inc. and Baptist Medical Center-Jacksonville – for $2.5 million.  The allegations first arose in a whistleblower lawsuit filed by former Baptist Neurology employee Verchetta Wells under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $26,250.  DOJ

Tagged in: FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

May 14, 2015

PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country, agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs.  The government’s allegations against PharMerica arose out of whistleblower lawsuit brought by Jennifer Denk, a pharmacist formerly employed by PharMerica, under the qui tam provisions of the False Claims Act.  Ms. Denk will receive a whistleblower award of $4.3 million.  Whistleblower Insider

Tagged in: FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

May 13, 2015

Olufunke Ibiyemi Fadojutimi, a registered nurse and former owner of Lutemi Medical Supply, was sentenced to four years in prison and ordered to pay restitution in the amount of $4,372,466 for her role in an $8.3 million Medicare fraud scheme.  The evidence at trial showed that Fadojutimi and her co-conspirators paid cash kickbacks to patient recruiters in exchange for patient referrals, and additional kickbacks to physicians for fraudulent prescriptions for medically unnecessary durable medical equipment, such as power wheelchairs.  DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME,

May 12, 2015

Alexander Lara,  an owner of Miami home health care company Longcare Home Health Corporation was sentenced to 10 years in prison and ordered to pay $13,771,528.94 in restitution and to forfeit $13,771,528.94 for his leading role in a $13 million Medicare fraud scheme that involved paying kickbacks and bribes to patient recruiters, Medicare beneficiaries and others in South Florida doctors’ offices and medical clinics.  Lara admitted his company fraudulently billed the Medicare program for expensive physical therapy and home health care services that were not medically necessary or not provided at all.  DOJ

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

May 7, 2015

Health Management Associates Inc. (and 14 hospitals it previously owned), along with Community Health Systems and North Texas Medical Center, agreed to collectively pay $15.69 million to settle whistleblower charges they violated the False Claims Act by seeking and receiving Medicare reimbursement for Intensive Outpatient Psychotherapy (IOP) services that were not medically reasonable or necessary.  The IOP services in question were typically performed on the providers’ behalf by Louisiana-based Allegiance Health Management.  The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The unidentified whistleblower will receive a whistleblower award of $2,667,300.  Whistleblower Insider

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

May 7, 2015

Tennessee-based Jackson-Madison County General Hospital agreed to pay $1,328,465 to resolve allegations it improperly billed Medicare and Medicaid for the placement of unnecessary cardiac stents and other unnecessary cardiac procedures including angioplasty, catheterization, and ultrasound imaging.  The allegations were first raised in a whistleblower lawsuit filed by Dr. Wood D. Deming under the qui tam provisions of the False Claims Act.  Mr. Deming will receive an undisclosed portion of the settlement as a whistleblower award.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Lack of Medical Necessity, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

April 30, 2015

Miami-area doctor Barry Kaplowitz was sentenced to 60 months in prison and ordered to pay more than $2.9 million in restitution for his role in a $5.5 million Medicare fraud scheme involving fraudulent billings by Hollywood Pavilion, a psychiatric hospital in Hollywood, Florida.  According to evidence, Kaplowitz signed fraudulent medical records in order to make it appear that the hospital’s patients qualified for and received intensive outpatient services, even though they did not.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

April 27, 2015

The Medical Center of Central Georgia agreed to pay $20 million to settle allegations it violated the False Claims Act by billing Medicare for more expensive inpatient services that should have been billed as less costly outpatient or observation services.  DOJ

Tagged in: FCA Federal, Hospital Fraud, Upcoding,

April 23, 2015

Louisiana doctor Winston Murray pleaded guilty to federal health care fraud charges, admitting (i) he wrote home health care referrals for Medicare beneficiaries he knew were not confined to their homes, and (ii) his referrals were used by home health companies Interlink Health Care Services Inc. and Lakeland Health Care Services Inc., among others, to fraudulently bill Medicare for home health services not medically needed or not provided.  From 2007 through 2014, these companies and other companies involved in this scheme submitted more than $56 million in claims to Medicare, a vast majority of which were fraudulent.  DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

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