Archive

May 21, 2021

SavaSeniorCare LLC and related entities (“Sava”) will pay $11.2 million, plus potentially more pursuant to an “ability-to-pay” settlement, to resolve allegations that Sava violated the False Claims Act by causing its skilled nursing facilities to bill Medicare for rehabilitation therapy services that were not reasonable, necessary, or skilled, and that Sava billed the Medicare and Medicaid programs for grossly substandard (i.e., “worthless”) skilled nursing services. The settlement stems from four separate qui tam complaints filed by whistleblowers Rita Hayward, Trammel Kukoyi, Terrence Scott, James Thornton, and Barbara Roberts, who will share an undisclosed portion of the government’s recovery. In 2015, the United States intervened in the litigation and filed a consolidated False Claims Act complaint, alleging inter alia that Sava had exerted significant pressure on its skilled nursing facilities to meet unrealistic corporate targets for the highest Medicare reimbursement rates without regard to patients’ actual clinical needs, and improperly delayed the discharge of patients from its facilities in order to increase billings. Sava will enter into a five-year Corporate Integrity Agreement as part of the settlement. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare, SNF, Upcoding, Whistleblower Case,

May 18, 2021

Javaid Perwaiz, an ob/gyn who practiced in Hampton Roads, Virginia, was sentenced to 59 years in prison after a jury convicted him of charges related to his performance of hysterectomies, sterilizations, and other medically unnecessary surgeries and procedures on patients without their informed consent - in many cases by falsely telling them they had cancer or needed the procedure to avoid cancer. In addition, Perwaiz induced labor in patients early so that he could bill for the deliveries, sometimes falsifying records to support the induction. USAO ED VA

Tagged in: Criminal Proceedings, Lack of Medical Necessity, Provider Fraud,

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

After being convicted of running a $11 million healthcare fraud scheme, Brenda Rodriguez, the owner and operator of Texas-based QC Medical Clinic, has been ordered to spend 25 years in prison, followed by 3 years of supervised release. As shown by evidence presented at trial, Rodriguez’s scheme involved paying doctors to approve Medicare beneficiaries for home health services, selling the approvals to various home health providers, and causing the providers to bill Medicare for services that were medically unnecessary, never provided, and/or arose from illegal inducements. USAO SDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare,

April 29, 2021

Over two dozen defendants who were part of an extensive prescription drug fraud scheme involving Alabama-based Northside Pharmacy d/b/a Global Compounding Pharmacy have been sentenced to prison. The defendants included company executives and managers, prescribers, billers, and sales representatives who, between 2013 and 2016, billed insurers such as Medicare and TRICARE for massive quantities of medically unnecessary prescription drugs. In just that short period of time, the defendants caused insurers to pay nearly $50 million in medically unnecessary claims, with more than $13 million arising from improper payments to prescribers, and more than $8.4 million for prescriptions written out to Global employees themselves. USAO NDAL

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

April 27, 2021

Indivior plc and Indivior Inc., will pay $300 million to settle claims from all 50 states, the District of Columbia, and Puerto Rico, alleging they caused the misuse of state Medicaid funds by falsely marketing the drug Suboxone. Suboxone is used by recovering opioid addicts to reduce withdrawal symptoms. According to the governments, Indivior promoted the sale and use of Suboxone for unsafe, ineffective, and medically unnecessary purposes, including by claiming it was less susceptible to abuse even though the active ingredient, buprenorphine, is a powerful opioid itself. Additionally, the company took steps to fraudulently delay the entry of generic alternatives in order to control pricing. The settlement resolves six whistleblower suits pending in New Jersey and Virginia. Indivior previously paid $600 million to resolve federal claims, and former parent company Reckitt Benckiser previously paid $1.4 billion to resolve the same. CA AG; FL AG; MI AG

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Misrepresentations, Whistleblower Case,

March 18, 2021

A Michigan-based cardiologist, Dinesh Shah, and his practice, Michigan Physicians Group, P.C. (MPG), have agreed to pay $2 million to resolve allegations of defrauding Medicare, Medicaid, and TRICARE by submitting claims for medically unnecessary diagnostic testing, in violation of the False Claims Act. In separate qui tam suits filed by former employees Arlene Klinke and Khrystyna Mala, the whistleblowers alleged that between 2006 and 2017, Shah and MPG billed government healthcare programs for Ankle Brachial Index tests, Toe Brachial Index tests, and Nuclear Stress Tests that were ordered and provided without regard to necessity. USAO EDMI

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

March 16, 2021

Jack Lee Stapleton and Jack Hunter Stapleton, the former owners of a Florida-based telemarketing company known as CV McDowell LLC or J&J Tel Marketing LLC (the Stapleton Entities), have agreed to pay at least $4 million to resolve a qui tam case by a former employee alleging violations of the False Claims Act. According to whistleblower Dwayne Thornton, the Stapletons solicited prospective patients through telemarketing calls, convinced them to accept compounded drugs regardless of need, and then procured prescriptions and sent them to compounding pharmacies that agreed to pay the Stapletons half of all TRICARE reimbursements. USAO MDFL

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

March 8, 2021

Vascular surgeon Feng Qin and his medical practice Qin Medical P.C. will pay $800,000 to resolve civil claims and criminal charges that Qin performed procedures on end-stage renal disease patients that were not medically reasonable and necessary, and fraudulently billed Medicare. Qin performed vascular access procedures on patients on a routine scheduled basis, without documenting the required clinical findings. The government’s investigation was initiated by the filing of a qui tam complaint by Mark Favors. USAO SDNY

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

March 3, 2021

The CEO of a group of medical providers in Michigan and Ohio has been sentenced to 15 years in prison and ordered to pay over $51 million in restitution to Medicare, as well as forfeit over $11.5 million in cash along with multiple properties and a Detroit Pistons season ticket membership, following a trial that found him guilty for his role in an extensive fraud scheme against Medicare. Mashiyat Rashid, the CEO of Tri-County Wellness Group, allegedly instituted a corporate policy that forced patients—many of whom were addicted to opioids and recruited from homeless shelters and soup kitchens—to submit to medically unnecessary but highly reimbursed back injections in exchange for prescriptions to medically unnecessary opioids. To implement the policy, Rashid made a point to hire physicians who were willing to put profit over patient care, further incentivizing them by offering to split reimbursements with them. Yet according to trial testimony, many of the patients did not want, need, or benefit from the painful back injections, which left some of them suffering from adverse conditions, including open holes in their back. Rashid is the second defendant to be sentenced in this case; twenty-one other defendants, including two physicians, have been convicted so far. DOJ

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

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