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February 24, 2015

Acadiana Cardiology LLC, Acadiana Cardiovascular Center and convicted doctor Mehmood Patel agreed to pay $650,000 to settle charges they violated the False Claims Act through unnecessary cardiovascular, endovascular and related procedures that Patel performed at Our Lady of Lourdes Hospital, Lafayette General Medical Center, Acadiana Cardiology and Acadiana Cardiovascular Center.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Christopher Mallavarapu, a cardiologist who formerly practiced with Patel.  DOJ

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

February 24, 2015

Angel M. Mirabal, owner of Houston-based medical equipment supplier Quick Solutions Medical Supplies Inc., pleaded guilty to a $5M scheme to defraud Medicare.  Mirabel admitted he and his co-conspirators operated Quick Solutions for the purpose of billing Medicare for medical equipment not medically necessary or not provided.  DOJ

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

February 18, 2015

Hospice services provider Compassionate Care Hospice Group agreed to pay $6.7M to settle charges it violated the federal and New York False Claims Acts by submitting claims to Medicare and Medicaid for hospice nursing services not actually or adequately provided.  Specifically, the government alleged CCH nurses routinely missed their required visits and then falsified nursing notes in patients’ files to make it appear as though the visits had been performed.  The charges originated in a whistleblower lawsuit filed by a former employee under the qui tam provisions of the False Claims Act.  Whistleblower Insider, NY

Tagged in: FCA Federal, FCA State, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

February 13, 2015

Illinois physician Dr. Michael J. Reinstein pleaded guilty to the crime of receiving illegal kickbacks and benefits totaling nearly $600,000 from pharmaceutical manufacturer Teva Pharmaceuticals USA Inc. and its subsidiary IVAX LLC in exchange for regularly prescribing the anti-psychotic drug clozapine to his patients.  Reinstein also agreed to pay $3.79M to settle a parallel civil lawsuit alleging he violated the False Claims Act for causing the submission of false claims to Medicare and Medicaid for the clozapine he prescribed for thousands of elderly and indigent patients in at least 30 Chicago-area nursing homes and other facilities.  In March 2014, Teva Pharmaceuticals and IVAX paid $27.6M million for their role in the kickback scheme. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Lack of Medical Necessity, Pharma Fraud, Provider Fraud,

February 10, 2015

Iowa-based home healthcare company ResCare Iowa Inc. agreed to pay $5.63M to resolve allegations it violated the False Claims Act by submitting false home healthcare billings to the Medicare and Medicaid programs.  DOJ

Tagged in: FCA Federal, Home Health and Hospice, Medical Billing Fraud,

February 10, 2015

Orelvis Olivera, the owner of Miami home health care agency Acclaim Home Healthcare Inc., pleaded guilty for his role in a $6.9M Medicare fraud scheme.  Olivera admitted he and his co-conspirators billed Medicare for expensive physical therapy and home health care services not medically necessary and paid kickbacks and bribes to patient recruiters in exchange for patient referrals.  DOJ

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

February 9, 2015

Wesley Harlan Kingsbury, general manager of California-based Alpha Ambulance Inc., was sentenced to 78 months in prison for his role in a $5.5M Medicare fraud scheme under which his company billed Medicare for ambulance transportation services for individuals that did not need them.  DOJ

Tagged in: Lack of Medical Necessity, Provider Fraud,

February 6, 2015

Oklahoma-based Hospice care provider Good Shepherd Hospice Inc.agreed to pay $4M to resolve allegations it submitted false claims for hospice patients who were not terminally ill. Specifically, the government contended Good Shepherd pressured staff to meet admissions and census targets and paid bonuses to staff, including hospice marketers, admissions nurses and executive directors, based on the number of patients enrolled even if they were not eligible for hospice care. The settlement resolves allegations first raised by former Good Shepherd employees Kathi Cordingley and Tracy Jones in a whistleblower lawsuit they filed under the qui tam provisions of the False Claims Act. They will receive a whistleblower award of approximately $680,000. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

February 6, 2015

A federal jury in Detroit convicted unlicensed Detroit physician Wilfred Griffith for his participation in a nearly $4.7M fraud scheme. According to evidence presented at trial, Griffith worked as an unlicensed physician at Phoenix Visiting Physicians in 2010 and 2011 where he treated Medicare beneficiaries and used prescription pads pre-signed by Dr. Dwight Smith to prescribe medicine. He also referred Medicare beneficiaries to Detroit-area home health company Cherish Home Health Services Inc. in exchange for kickbacks. Griffith used the names and signatures of Dr. Smith and two other Detroit-area physicians to certify the beneficiaries were homebound and needed home health services when they did not. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medical Billing Fraud, Provider Fraud,

February 5, 2015

Minnesota-based medical device manufacturer ev3 Inc. (formerly known as Fox Hollow Technologies Inc.) agreed to pay $1.25M to resolve allegations it violated the False Claims Act by causing certain hospitals to submit false claims to Medicare for unnecessary inpatient admissions related to minimally-invasive atherectomy procedures for removing hardening of the arteries. According to the government, Fox Hollow sold the Silver Hawk Plaque Excision System for these procedures and advised hospitals to bill them as more expensive inpatient procedures, as opposed to less costly outpatient procedures, to artificially increase their Medicare reimbursement claims. The charges originated with a whistleblower lawsuit was filed under the qui tam provisions of the False Claims Act by former Fox Hollow sales representative Amanda Cashi. She will receive a whistleblower award of $250,000. DOJ

Tagged in: FCA Federal, Hospital Fraud, Medical Billing Fraud, Medical Devices and DME, Upcoding, Whistleblower Case, Whistleblower Rewards,

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