Archive

September 30, 2016

A $6.15 million judgment was entered against Maryland-based home health care agency Speqtrum Inc. for violating the False Claims Act through a "massive and routine pattern of fraud by high-level employees" including the forging of necessary signatures and the falsification of timesheets.  DOJ (DC)

September 29, 2016

North Carolina-based Branch Banking & Trust Company agreed to pay $83 million to resolve allegations that it violated the False Claims Act by knowingly originating and underwriting mortgage loans insured by the U.S. Department of Housing and Urban Development’s Federal Housing Administration that did not meet applicable requirements.  As part of the settlement, BB&T admitted that it certified for FHA insurance mortgage loans that did not meet HUD underwriting requirements and did not adhere to FHA’s quality control requirements.  DOJ

September 28, 2016

Pennsylvania-based hospital chain Vibra Healthcare LLC agreed to $32.7 million to resolve claims it violated the False Claims Act by billing Medicare for medically unnecessary services.  According to the government, Vibra admitted numerous patients to five of its long term care hospitals and one of its inpatient rehab facilities who did not demonstrate signs or symptoms that would qualify them for admission.  In addition, Vibra allegedly extended the stays of its long term care patients without regard to medical necessity, qualification and/or quality of care.  In some instances, Vibra allegedly ignored the recommendations of its own clinicians, who deemed these patients ready for discharge.  The allegations originated in a whistleblower lawsuit filed by Sylvia Daniel, a former health information coder at Vibra Hospital of Southeastern Michigan, under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of at least $4 million from the proceeds of the government's recovery.  Whistleblower Insider

September 21, 2016

Michigan doctor Hussein Awada agreed to pay $200,000 to resolve charges he violated the False Claims Act by writing prescriptions for oxycodone and other controlled medications and billing for medical services without medical justification.  According to the government, Awada conspired with patient “marketers” to write prescriptions for tens of thousands of dosages of oxycodone and other controlled medications for no medical purpose and then used the patient data to submit bills to Medicare for services that were either never performed or were medically unjustified.  Awada also caused these same patients to receive medically unnecessary monthly x-rays, and other invasive tests, to help conceal his fraud.  Awada previously pled guilty to these charges and was sentenced to 84 months in prison and pay $2.3 million in restitution.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Heather Henson, who worked as a receptionist for Awada at his medical practice.  She will receive a whistleblower award of $36,000.  DOJ (EDMI)

September 19, 2016

North American Health Care Inc., a California-based operator of dozens of skilled nursing facilities (along with its Chairman John Sorenson and Senior Vice President of Reimbursement Analysis Margaret Gelvezon) agreed to pay $30 million to resolve charges they violated the False Claims Act by billing for medically unnecessary rehabilitation therapy services.  Whistleblower Insider

September 14, 2016

Healthmark Investment Trust, partial owner of Florida-based compound pharmacy QMedRx, agreed to pay $7.75 million to resolve allegations QMedRx violated the False Claims Act by billing the federal healthcare programs for prescriptions tainted within the meaning of the Anti-Kickback Statute.  The government is still pursuing penalties and fines from other owners and participants within QMedRx.  DOJ (MDFL)

September 14, 2016

Romy Macasaet and his Illinois-based home health care company Home Bound Healthcare, Inc. agreed to plead guilty and pay $6.8 million to resolve charges of violating the False Claims Act and the Anti-Kickback Statute by paying kickbacks to medical directors to obtain referrals of Medicare beneficiaries to his company, which was one of the largest home health care and hospice companies in Illinois.  Macasaet acknowledged that he retained and paid medical directors a monthly fee solely for the purpose of obtaining patient referrals and not for medical services, and that he used medical director agreements to conceal the payment of kickbacks.  As part of the settlement, Macasaet agreed to divest his ownership interest in Home Bound.  DOJ (NDIL)

September 12, 2016

Birmingham-based Regions Bank agreed to pay $52.4 million to settle charges that it violated the False Claims Act by knowingly originating and underwriting mortgage loans insured by the Department of Housing and Urban Development’s (HUD) Federal Housing Administration (FHA) that did not meet applicable requirements.  According to the government, Regions’ misconduct caused HUD to incur substantial losses by paying insurance claims for loans not eligible for FHA mortgage insurance.  Whistleblower Insider

September 9, 2016

Los Angeles nursing home Westlake Convalescent Hospital and two physicians who worked there, Dr. Jasvant Modi and his wife Dr. Meera Modi, agreed to pay $3,563,140 to resolve charges they violated the False Claims Act by participating in a scheme to improperly transfer patients recruited from the “Skid Row” district to a hospital for medically unnecessary services, and then transfer the patients from the hospital to the nursing home for medically unnecessary stays.  According to the government, Westlake paid illegal kickbacks to a “care consortium” on Skid Row in exchange for patient referrals to Westlake.  Jasvant Modi allegedly readmitted patients from Westlake to the now-closed Temple Community Hospital and then back to Westlake to extend the patients’ Medicare-covered stays at Westlake, knowing the patients did not require further services at either facility.  Meera Modi allegedly signed medical orders for non-payable services for these same patients. Westlake allegedly billed Medicare and Medi-Cal for medically unnecessary services provided to these patients.  The allegations originated in a whistleblower lawsuit brought by former Westlake employee Ricardo Gonzales under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $534,471 from the proceeds of the government's recovery.  DOJ (CDCA)

September 7, 2016

Medical equipment supply companies U.S. Healthcare Supply LLC and Oxford Diabetic Supply Inc., along with their owners and presidents, agreed to pay more than $12.2 million to resolve allegations that they violated the False Claims Act by making unsolicited calls to Medicare beneficiaries to sell them durable medical equipment.  According to the government, the two companies created a fictitious company called Diabetic Experts Inc., which they used to make the unsolicited calls, and then submitted claims to Medicare for the equipment they sold in violation of the Medicare Anti-Solicitation Statute.  Whistleblower Insider