Archive

August 9, 2021

The owners of North Carolina compounding pharmacy Wellcare Compouding, David Tsui and Lois Tsui, paid $1.1 million to resolve allegations that they violated the False Claims Act by submitting false claims for payment to the TRICARE program in 2014 and 2015. The government alleged that Wellcare made improper payments to physicians and “marketers” in violation of the Anti-Kickback Statute and encouraged medically unnecessary prescriptions consisting of high-margin ingredients in order to maximize the pharmacy’s reimbursement. David Tsui had been convicted of healthcare fraud in 2009 and was excluded from participation in federal healthcare programs; the government alleged that his involvement and ownership was intentionally concealed. USAO MD NC

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

August 6, 2021

Maryland-based National Spine & Pain Center (NSPC) and its affiliate, Physical Medicine Associates, Ltd. (PMA), have agreed to pay $5.1 million to Medicare and enter into a non-prosecution agreement to settle a criminal fraud investigation. In violation of the Anti-Kickback Statute, NSPC and PMA had conspired with a now-defunct California-based genetics testing company called Proove Biosciences to have Proove pay illegal kickbacks to NSPC and PMA physicians in exchange for a certain volume of test referrals. Nine individuals have been charged in connection with the scheme. USAO SDCA

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

August 2, 2021

Diabetic testing supply company Arriva Medical LLC and its parent company Alere Inc. will pay $160 million to resolve claims first brought in a whistleblower case alleging that Arriva provided unlawful patient inducements in the form of “free” or “no cost” glucometers and copayment waivers. Defendants were alleged to have systematically provided all new patients with glucometers, and billed Medicare for those meters, although Medicare beneficiaries are only eligible for a new meter once every five years. In addition, Arriva was alleged to have billed Medicare for deceased beneficiaries. The whistleblower, Gregory Goodman, who was an employee at an Arriva call center, will receive a whistleblower award of $28.5 million. Executives at Arriva previously agreed to a settlement of claims against them. DOJ; USAO MD Tenn

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Whistleblower Case, Whistleblower Rewards,

July 21, 2021

Alliance Family of Companies LLC, a national electroencephalography testing company, and Ancor Holdings LP, a private insurance company, have agreed to pay a combined $15.3 million to resolve alleged violations of the False Claims Act and Anti-Kickback Statute. According to a number of whistleblowers, Alliance provided free electroencephalography (EEG) interpretation reports to induce physician orders, caused physicians to submit false claims to the government, used inaccurate billing codes to generate higher reimbursements, and billed for a specialized digital analysis that it didn’t actually perform. The whistleblowers also alleged that while performing due diligence prior to investing in Alliance, Ancor learned of the kickbacks but allowed them to continue after the change in management. Two of the whistleblowers involved will share a reward of nearly $3 million. DOJ

Tagged in: Anti-Kickback and Stark, Defendants, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

July 19, 2021

Prime Healthcare Services, one of the largest hospital systems in the nation, its founder and CEO Dr. Prem Reddy, and interventional cardiologist Dr. Siva Arunasalam have agreed to pay $37.5 million to resolve two suits filed by former executive Martin Mansukhani, and former employees Marsha Arnold and Joseph Hill. In violation of the federal and California False Claims Acts, certain Prime hospitals had allegedly submitted inflated invoices to Medi-Cal and other government health programs, or submitted claims to Medi-Cal and Medicare under Arunasalam’s provider number for services provided by an excluded physician. Additionally, in acquiring Arunasalam’s physician practice and surgery center, Prime allegedly paid above fair market value for referrals from Arunasalam to one of their hospitals. For being the first to file, one of the whistleblowers, Mansukhani, will receive a relator’s share of nearly $10 million. CA AG; USAO CDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Medical Billing Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

June 28, 2021

Surgical Care Affiliates, LLC and Orlando Center for Outpatient Surgery, LP have agreed to pay $3.4 million to resolve a whistleblower’s allegations that they billed Medicare and TRICARE for medically unnecessary kidney stone procedures. The centers also engaged in an illegal kickback arrangement whereby urologist Dr. Patrick Hunter performed lithotripsy procedures in exchange for per-procedure payments from the Orlando Center. For bringing a successful action, whistleblower Scott Thompson will receive a relator’s share of $748,000 from the settlement with SCA and the Orlando Center. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 2, 2021

An Ohio-based hospital system that has since been acquired by the Cleveland Clinic Foundation has agreed to pay over $21 million to resolve alleged violations of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act. Between 2010 and 2016, Akron General Health System (AGHS) allegedly paid area physician groups far above fair market value in order to induce referrals, then submitted claims arising from those illegal referrals to federal healthcare programs. The settlement resolves a qui tam suit brought forth by former internal audit director at AGHS, Beverly Brouse, and Ethical Solutions LLC. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Provider Fraud, Whistleblower Case,

May 19, 2021

In one of the first settlements to resolve allegations under both the False Claims Act and the Open Payments Program (formerly the “Sunshine Act”), French medical device manufacturer Medicrea International and its American affiliate, Medicrea USA Inc., have agreed to pay $2 million to resolve whistleblower Dory Frain’s allegations that the companies violated the Anti-Kickback Statute while entertaining U.S.-based physicians at a conference in France in 2013. The settlement also resolves allegations that the companies violated the Open Payments Program by failing to report those expenses to the Centers for Medicare & Medicaid Services. USAO EDPA; CA AG; FL AG

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Medical Devices and DME, Whistleblower Case,

May 10, 2021

The University of Miami, which operates multiple hospitals and other healthcare facilities, will pay $22 million to resolve claims arising from allegedly fraudulent billing submitted to federal healthcare programs for laboratory services. The university was alleged to have billed certain laboratory tests as having been provided at hospital facilities instead of at physician offices, without satisfying the requirements for that more costly hospital facility billing, including notice requirements. In addition, the university was alleged to have performed and billed for a pre-set panel of tests for all kidney transplant patients, although not all included tests were medically necessary. Finally, the university and Jackson Memorial Hospital, which jointly operated the kidney transplant program, were alleged to have violated related party restrictions by billing for pre-transplant laboratory tests ordered by JMH from the university, and JMH will pay an additional $1.1 million to settle these allegations. The settlement resolves claims made in three separate qui tam lawsuits; the whistleblower's share has not yet been determined. DOJ; USAO SD FL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,

May 4, 2021

Delaware-based pharmaceutical company Incyte Corporation has agreed to pay $12.6 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act in connection with its myelofibrosis drug, Jafaki. Despite federal laws against illegal remuneration to federal healthcare program beneficiaries, Incyte allegedly wielded its influence as the sole donor of a foundation to coerce the foundation into illegally covering the copays of Medicare and TRICARE patients taking Jafaki. The misconduct continued from 2011 through 2014 before it was revealed in a qui tam suit by former compliance executive turned whistleblower, Justin Dillon. Dillon will receive approximately $3.59 million for his efforts. DOJ; USAO EDPA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

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