Archive

August 31, 2016

Clear Vue Eye Center and its owner, Dr. Monique Barbour, agreed to pay $1 million to resolve allegations that they violated the False Claims Act by overbilling Medicare for patient visits at nursing homes and assisted living facilities, and for billing for procedures purportedly performed while Dr. Barbour was out of the country.  According to the government, Dr. Barbour billed excessively for patient visits, billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period.  Records reviews show that many of the procedures billed were medically unnecessary with little patient benefit and that Dr. Barbour billed procedures at the most profitable rates regardless of the procedure’s proper billing code.  The allegations originated in a whistleblower lawsuit brought by former Clear Vue employee Lori Moore under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $200,000 from the proceeds of the government's recovery.  DOJ (SDFL)

August 25, 2016

Fairbanks Morse Engine agreed to pay $142,500 to settle charges it violated the False Claims Act by overcharging the Navy on a subcontract for engine repairs on the USS Ashland.  DOJ (EDVA)

August 24, 2016

New York hospitals Beth Israel Medical Center (d/b/a Mount Sinai Beth Israel), St. Luke’s-Roosevelt Hospital Center (d/b/a Mount Sinai St. Luke’s) and Mount Sinai Roosevelt, and Continuum Health Partners, agreed to pay $2,950,000 to settle charges that they violated the federal and New York False Claims Act by willfully delaying repayment of over $800,000 in Medicaid overpayments that resulted from improper claims submitted because of a software error.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery.  DOJ (SDNY)

August 24, 2016

The insurance carrier for defunct, for-profit cosmetology school B&H Education, Inc., which operated the Marinello Schools of Beauty in locations across Southern California, agreed to pay $8,631,000 to resolve allegations the school violated the False Claims Act by obtaining federal student loan funds for ineligible students who received bogus high school diplomas.  The allegations originated in a whistleblower lawsuit filed by six former B&H employees under the qui tam provisions of the False Claims Act.  The whistleblowers will collectively receive a whistleblower award of $2.5 million from the proceeds of the government's recovery.  In addition to the $8.6 million payment, the insurer will also pay $2,369,000 to the six whistleblowers’ attorneys.  DOJ (CDCA)

August 17, 2016

Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital and affiliated entities including a related pain clinic, Lehigh Valley Pain Management, agreed to pay $690,441 to resolve allegations they violated the False Claims Act by submitting false health care billings for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising.  The allegations originated in whistleblower lawsuit filed Margaret Reynard under the qui tam provisions of the False Claims Act.  Ms. Reynard will receive a whistleblower award of roughly $124,000 from the proceeds of the government's recovery.  DOJ (EDPA)

August 17, 2016

Florida urologist Robert A. Scappa agreed to pay $250,000 to resolve allegations that he violated the False Claims Act by causing claims to be submitted to federal health care programs for laboratory tests that were not medically necessary.  During the relevant time period, Scappa was a urologist practicing as part of Scappa Urology, which was a division of 21st Century Oncology, LLC., a nationwide provider of integrated cancer care services.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former medical assistant who worked for Dr. David Spellberg of Naples Urology Associates, which was also a division of 21st Century Oncology.  The whistleblower will receive an award of $37,500 from the government's recovery.  This amount is in addition to a $3.2 million share she will receive as the result of the $19.75 million settlement previously reached with 21st Century Oncology.  DOJ (MDFL)

August 16, 2016

Pittsburgh-based national banking association PNC Bank N.A. agreed to pay $9.5 million to resolve allegations it violated the False Claims Act in connection with the issuance of loans guaranteed by the Small Business Administration (SBA).  According to the government, for numerous loans brokered by Jade Capital & Investments LLC., PNC failed to adhere to the requirements of the SBA program including demanding adequate bank and IRS tax records from the borrowers, ensuring that the borrowers had the ability to repay the loans, and failing to apply prudent lending standards.  Whistleblower Insider

August 24, 2016

New York and the Justice Department announced that three hospitals in the Mount Sinai Health System are paying a total of $2.95 million to resolve allegations that the hospitals knowingly retained over $844,000 in overpayments made by Medicaid in violation of the federal and New York False Claims Acts. Knowing retention of an overpayment from the government for more than sixty days is known as a “reverse false claim” and is a violation of both federal and state false claim acts. The entities involved include Mount Sinai Beth Israel (“Beth Israel”) (formerly Beth Israel Medical Center), Mount Sinai St. Luke’s (“St. Luke’s”) (formerly St. Luke’s Hospital) and Mount Sinai Roosevelt (“Roosevelt”) (formerly Roosevelt Hospital) (together, the “Hospitals”) – and the Hospitals’ former partnership group, Continuum Health Partners, Inc. (“Continuum,” and together with the Hospitals, “Defendants”). As part of the settlements, Defendants admitted that, beginning in 2009 due to a software compatibility issue, a coding error caused Defendants to submit claims for payment above and beyond what they had received from the managed care organization, and that Medicaid paid these claims as a secondary payor. In September 2010, the New York Office of the State Comptroller brought to Continuum’s attention a small number of these claims, and Defendants admitted that in late 2010 they were made aware of the coding error. NY

August 24, 2016

Six former employees of defunct for-profit cosmetology school B&H Education, Inc., which operated the Marinello Schools of Beauty in locations across Southern California, will receive a whistleblower award of $2.5 million from the $8.6 million B&H's insurance carrier agreed to pay to resolve allegations that B&H violated the False Claims Act by obtaining federal student loan funds for ineligible students who received bogus high school diplomas.  DOJ (CDCA)

August 12, 2016

Massachusetts-based research and development company Agiltron, Inc. and its president, Jing Zhao, agreed to pay $2.25 million to resolve allegations that they violated the False Claims Act by seeking disbursements from federal agencies for falsified labor costs in order to maximize charges to grants and contracts awarded by federal agencies.  Agiltron received funds under 15 grants and contracts awarded through the federal Small Business Innovation and Small Business Technology Transfer programs.  According to the government, Agiltron and Zhao engaged in a scheme in which they directed employees to charge labor hours to the awards that did not correspond with their actual time and effort, to alter their completed timesheets, and to discard or destroy documents.  DOJ (DMA)