Archive

January 20, 2015

Florida Attorney General Pam Bondi’s Medicaid Fraud Control Unit arrested six former Targeted Case Managers of DS Connections, Inc. for more than $170,000 in Medicaid fraud. FL

Tagged in: Healthcare Fraud, Medicaid,

January 16, 2015

Washington Attorney General Bob Ferguson announced Sea Mar Community Health Centers agreed to pay $3.35M to settle charges of improperly billing Medicaid for thousands of dental appointments. According to the government, Sea Mar billed fluoride treatments as stand-alone appointments with a dentist or hygienist when they could have been performed much more cheaply by dental assistants as part of a patient’s regular six-month checkups. WA

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

January 7, 2015

Florida Attorney General Pam Bondi announced that Florida, along with California, Colorado, Kentucky, and Ohio and the federal government, entered a $22 million national settlement with DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the US. The settlement resolves allegations originating in a whistleblower lawsuit that DaVita paid illegal kickbacks to induce the referral of patients to its dialysis clinics, causing false claims to be submitted to the Medicaid program. DaVita will pay Florida $5.6 million in restitution and other recoveries. FL

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Medicaid, Provider Fraud,

October 31, 2014

Oklahoma-based dental company, Ocean Dental PC, which operates 28 clinics in seven states, agreed to pay more than $5M to settle charges it violated the False Claims Act by submitting false claims to the Oklahoma Medicaid program for dental work never performed or billed at a higher rate than allowed. The charges apparently stem from dental restorations by former employee Robin Lockwood who was sentenced to 18 months in federal prison in a separate case. NewsOK

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

October 16, 2014

Texas Attorney General Greg Abbott entered into a settlement with generic drug maker Ranbaxy Pharmaceuticals, Inc., Ranbaxy Laboratories, Inc., Ranbaxy USA, Inc. and Ranbaxy, Inc. to resolve allegations they violated the Texas Medicaid Fraud Prevention Act by fraudulently reporting inflated drug prices to the Medicaid program. Under the settlement, Ranbaxy must pay the State of Texas about $18M. TXAG

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

September 26, 2014

Pharmacy benefit management (PBM) company Caremark LLC agreed to pay $6 million to settle charges of failing to reimburse Medicaid for prescription drug costs that should have been paid for by Caremark-administered private health plans. Caremark is operated by CVS Caremark Corporation, one of the largest PBMs and retail pharmacies in the country. Donald Well, former employee of Caremark, will receive a whistleblower award of $1 million from the $6 million False Claims Act settlement. DOJ

Tagged in: FCA Federal, Medicaid, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

September 18, 2014

New York Attorney General Eric T. Schneiderman announced that 46 states and the District of Columbia have reach a settlement agreement with Minnesota-based company Medtronic to resolve claims under the False Claims Act that Medtronic improperly induced physicians to recommend Medtronic devices to treat cardiac rhythmic disease. New York led a national team composed of members from Oregon, Texas and California to negotiate the settlement. The federal government settled its matter in May of this year. The agreement requires Medtronic to pay the settling states $362,362 which will go to those states’ Medicaid programs. The matter was brought by a whistleblower, Adolfo Schroeder. NYAG

Tagged in: Healthcare Fraud, Medicaid, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

August 6, 2014

New York Attorney General Eric T. Schneiderman announced he, along with 40 other state Attorneys General and the District of Columbia, reached a $35M settlement with Pfizer arising from alleged improper marketing and promotion of the immunosuppressive drug Rapamune. New York’s share of the settlement is over $1.7M. Pfizer, as parent of Wyeth Pharmaceuticals Inc., agreed to be bound by the judgment and to resolve allegations that Wyeth unlawfully promoted Rapamune. Attorney General Schneiderman’s office served on the Executive Committee of this multi-state investigation. NYAG

Tagged in: FCA State, Medicaid, Off-Label and Unapproved Use, Pharma Fraud,

January 5, 2014

New York Attorney General Eric T. Schneiderman announced that Apple Transportation of New York, Inc. will pay $300,000 to settle claims it overbilled Medicaid for transportation services. As part of a settlement agreement, Apple Transportation admitted that between January 1, 2004 and October 30, 2008, it frequently billed Medicaid for ambulette services even though no personal assistance was provided to Medicaid recipients. As a result, Apple was paid by Medicaid for ambulette services at rates that were higher than the applicable livery rates. NY

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

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