June 11, 2019

Two additional co-defendants in a recently reported home health fraud case have been sentenced to 6-10 years in prison and ordered to pay over $4.3 million each for their involvement.  Angela Avetisyan and Ashot Minasyan, the co-owners and operators of Fifth Avenue Home Health, paid kickbacks to Marina Merino and other patient recruiters to bring Medicare patients to a clinic owned by Robert Glazer.  In exchange, they received referrals from...

June 7, 2019

Robert A. Glazer and Marina Menino have been found guilty at trial for their actions directing a Medicare fraud scheme that billed $33 million to the government.  Menino received kickbacks from Glazer in exchange for recruiting patients for his Glazer Clinic.  Glazer then billed Medicare for services the patients did not need or did not receive, referred them to medically unnecessary home health or hospice services, and ordered durable medical...

Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Opioid manufacturer Insys Therapeutics agreed to a $225 million settlement related to allegations that it unlawfully marketed its drug Subsys and paid kickbacks to providers through “speaker programs” that rewarded providers who prescribed Subsys. We previously asked whether our readers thought CEOs should be more liable for corporate wrongdoing after the Insys CEO was convicted for participating in a criminal racketeering conspiracy. The proliferation of kickback schemes, evidenced by the...

June 5, 2019

Opioid manufacturer Insys Therapeutics will pay $225 million to resolve federal criminal and civil claims against it regarding the unlawful marketing of its drug Subsys, including the payment of kickbacks to providers through sham "speaker programs" that rewarded practitioners who increased their Subsys prescribing, as well as jobs for prescribers' relatives and friends, and lavish meals and entertainment.  $195 million of the settlement will be paid to resolve False Claim...

June 3, 2019

A former physician’s assistant in New Hampshire has been sentenced to 4 years in prison for writing prescriptions of a fentanyl spray in exchange for over $49,000 in kickbacks masked as speaker honorariums.  After being approached by a drug manufacturer in 2013, Christopher Clough wrote upwards of 750 prescriptions for the spray, which was intended for management of breakthrough cancer pain (BTCP).  Over 215 of those prescriptions were for Medicare...

WATCH THIS SPACE: Proposed $700M Fix for Installed Foreign-Telecom Could Compound Fraud Related to Universal-Service-Fund Projects

Congress, the President, and the FCC are moving to restrict and phase out foreign-made telecommunications components seen as national security risks. While the president’s executive order of May 15, 2019 prohibits U.S. companies from buying foreign telecom, we have a huge problem: our systems already have large quantities of this equipment installed – antennas, radios, electronics, routers, services, etc. The Commerce Department is allowing U.S. companies 90-days to wrap up...

United States Intervenes in Home Health Care Fraud Case

Last week, the United States intervened in a lawsuit brought against Florida-based Doctor’s Choice Home Care and its two owners.  The Department of Justice alleged that the company bribed doctors to refer patients in violation of the federal Anti-Kickback Statute and Stark Law. Both laws prohibit medical providers from paying or receiving kickbacks in connection with government-funded health care programs. According to federal prosecutors, Doctor’s Choice offered sham medical directorships...

Anti-Kickback Statute and Stark Law

Whistleblowers Can Report Violations of the Anti-Kickback Statute and Stark Law Using the False Claims Act The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of financial relationships. Kickbacks and Unlawful Payment Arrangements...

Healthcare & Pharmaceutical Fraud

What potential whistleblowers need to know about reporting fraud in the healthcare industry [caption id="attachment_44193" align="alignright" width="400"] Click for full size image[/caption] Fraud in the healthcare, pharmaceutical, and durable medical equipment industries is significant and contributes substantially to rising healthcare costs. And sadly, it can be pervasive during a national or worldwide health crisis. The federal and state governments collectively spend hundreds of billions of dollars every year on healthcare...

May 29, 2019

Almirall, LLC, f/k/a Aqua Pharmaceuticals, LLC , will pay $3.5 million to settle kickback allegations exposed by a former Aqua sales representative.  According to the whistleblower, the pharmaceutical company paid kickbacks in the form of free meals, trips, gift cards, and gifts, to dermatology providers in exchange for prescriptions of their drugs to Medicare and TRICARE patients.  It also paid kickbacks by compensating healthcare providers for speaking engagements and consulting...