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July 10, 2020

Universal Health Services, Inc. and UHS of Delaware, Inc. (collectively, UHS), and a Georgia-based UHS facility, Turning Point Care Center, LLC, have agreed to pay a combined $122 million to settle 18 qui tam cases pending in four jurisdictions.  In violation of the False Claims Act, UHS allegedly billed federal healthcare programs—including Medicare, Medicaid, TRICARE, the Department of Veteran Affairs, and the Federal Employee Health Benefit programs—for medically unnecessary inpatient behavioral health services, failed to provide adequate or appropriate services, and paid illegal inducements to beneficiaries of those programs.  UHS will pay over $88 million to the federal government and nearly $29 million to individual states, for a combined penalty of $117 million, with a relator share of about $15.8 million.  Turning Point will pay $5 million to the federal government and the State of Georgia; the whistleblower in that case will receive $861,853.64.  USAO MDFL; USAO NDGA; USAO EDPA; AG FL; AG MI; AG NC; AG VA

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

July 8, 2020

An orthopedic hospital, its management company, a physician’s group, and two physicians have agreed to pay $72.3 million to resolve whistleblower-brought allegations under the Anti-Kickback Statute, federal False Claims Act, and Oklahoma Medicaid False Claims Act of defrauding Medicare, Medicaid, and TRICARE.  Between 2006 and 2018, the Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM) and its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), allegedly provided free or below-fair market rate services and compensation to Southwest Orthopaedic Specialists, PLLC (SOS), including SOS physicians Anthony Cruse, D.O., and R.J. Langerman, Jr., D.O., in exchange for patient referrals.  USP also allegedly offered preferential investment opportunities to physicians in Texas.  As part of the settlement, USP will pay $60.86 million to the United States, $5 million to the State of Oklahoma, and $206,000 to the State of Texas, while SOS and its physician defendants will pay $5.7 million to the United States and $495,619 to the State of Oklahoma.  DOJ

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

July 1, 2020

Novartis Pharmaceuticals Corporation will pay a total of $678 million to resolve a case brought by a whistleblower, Oswald Bilotta, alleging that between 2002 and 2011 the pharmaceutical company violated the Anti-Kickback Statute and False Claims Act by providing doctors with cash payments and luxury travel and meals to induce them to prescribe Novartis cardiovascular and diabetes drugs reimbursed by federal healthcare programs.  The total settlement consists of $591.4 million as federal FCA damages, $48.2 million as state FCA damages for Medicaid false claims submitted to 28 states and the District of Columbia, and $38.4 million as forfeiture under the Anti-Kickback Statute.  The whistleblower award has not yet been determined.  In addition to the monetary settlement, Novartis entered into a Corporate Integrity Agreement obligating the company to, among other things, significantly reduce its volume and spending on paid speaker programs.  DOJ; USAO SDNY; CA AG; MI AG; NY AG

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

June 24, 2020

Augusta University Medical Center (AUMC) has agreed to pay $2.6 million to resolve fraud allegations by the United States, State of Georgia, and State of South Carolina under state and federal False Claims Acts.  According to the government, AUMC knowingly submitted claims to Medicare and Medicaid for a medically unnecessary procedure that was billed as a covered procedure.  USAO SDGA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare,

April 29, 2020

North Carolina physician Ibrahim Oudeh and his wife Teresa Sloan-Oudeh will pay up to $8.8 million to resolve claims of Medicare and Medicaid fraud.  Between 2010 and 2017, the Oudehs reportedly submitted more than 40,000 false claims, including more than 37,000 claims for laboratory tests, including nerve-conduction studies that Dr. Oudeh was not qualified to interpret, the vast majority of which were medically unnecessary.  To submit as many claims as they did, defendants falsely billed for office visits, in some instances billing for more than 24 hours of visits in a single calendar day.  The Oudehs sometimes used outside physicians to interpret laboratory tests, but paid those physicians less than their practice’s Medicare reimbursement, a violation of the Anti-Markup Rule.  Defendants will forfeit $3.3 million in assets and pay an additional $5.5 million.   USAO EDNC; NC

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Provider Fraud,

April 29, 2020

Ecotrust Forest Management and its non-profit affiliate, Ecotrust, will pay $4.4 million to resolve claims under the Oregon False Claims Act that they fraudulently claimed entitlement to New Market Tax Credits, which are meant to provide incentives for economic development in disadvantaged areas of the state, on their financing of two development projects, the Rough & Ready Sawmill in Cave Junction and the purchase of forestland in Desolation Creek.  The companies allegedly overstated their expenses on the projects in order to secure larger tax credits.  OR

Tagged in: FCA State, Government Programs Fraud, Tax Credit and Deduction Fraud,

February 4, 2020

Psychotherapy, adolescent therapy, and tutoring company The Center of Attention, LLC: No One Left Behind, together with its owner Selina Christian, will pay $200,000 and be suspended from Connecticut's Medicaid program, based on allegations that defendants violated the Connecticut False Claims Act and submitted false claims for services that were either never provided, or that were for non-psychotherapy services that were not covered by Medicaid.  CT

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

January 16, 2020

Udaya Shetty, a psychiatrist in Virginia, was sentenced to over two years in prison and has agreed to pay over $1 million to the United States and the Commonwealth of Virginia to resolve allegations of submitting false claims to Medicare, Medicaid, and TRICARE.  Shetty was accused of billing for services that average about 40-60 minutes long, despite quadruple booking patients and only seeing them for about 5-10 minutes each.  The scheme began at his own practice, Behavioral & Neuropsychiatric Group, in 2013, and continued at a new practice, Quietly Radiant Psychiatric Services, in 2017.  As a result of his actions, government health programs were defrauded of more than $450,000.  USAO EDVA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs,

December 19, 2019

Nassir Medical Corp., which does business as the Cancer Care Institute, and its owner, Dr. Youram Nassir, have agreed to pay $3.4 million to resolve allegations that they violated the False Claims Act by billing Medicare and Medicaid for oncology drugs that were not actually purchased, dispensed, or administered, and for infusion services that were not actually provided.  The case was initiated by whistleblower Kenneth Bryan, who will receive a whistleblower reward of $475,000 from the federal government.  USAO CD Cal

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 17, 2019

India-based outsourcing and business consulting firm Infosys Ltd. has agreed to pay $800,000 to the State of California to resolve allegations that the company misclassified approximately 500 Infosys employees as working in California on B-1 visas rather than H-1B visas.  By using the B-1 visas, Infosys avoided California payroll taxes and avoided the H-1B obligation to pay workers at the local prevailing wage.  The case was initiated by a whistleblower complaint under the California False Claims Act filed by Jack "Jay" B. Palmer, who will receive 15% of the settlement.  CA

Tagged in: FCA State, Visa Fraud, Whistleblower Case, Whistleblower Rewards,

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