Whisleblower News From The Inside -- April 30, 2018

By the C|C Whistleblower Lawyer Team Whistleblowers Hope for an Ally at IRS – Tipsters have helped the Internal Revenue Service collect $3.6 billion since 2007. Whistleblower lawyers hope Charles Rettig, the potential next leader of the agency, will make it easier to bring in still more cash. Mr. Rettig, a California tax lawyer, is President Donald Trump’ nominee for IRS commissioner. He has worked extensively with people caught up...

March 29, 2018

Juan Yrorita, the assistant director of nursing at Detroit area home health agency Annointed Care Services, was sentenced to 36 months in prison and pay and forfeit roughly $50 million for his role in a scheme involving approximately $1.6 million in fraudulent Medicare claims for home health services that were procured through the payment of kickbacks, and that were medically unnecessary and not provided. DOJ

February 28, 2018

Rafael Arias, the owner of numerous Miami-area home health agencies, was sentenced to 240 months in prison and pay $66.4 million in restitution for his role in a $66 million conspiracy to defraud the Medicare program. As part of his guilty plea, Arias admitted recruiting nominee owners to falsely and fraudulently represent themselves as the agencies’ owners to hide his identity and ownership interest. Arias and his co-conspirators paid illegal...

February 22, 2018

Samuel Konell was sentenced to 60 months in prison and pay roughly $10 million for his role in a $63 million health care fraud scheme involving now-defunct Greater Miami Behavioral Healthcare Center Inc. which purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness. Konell admitted he received kickbacks and/or bribes in return for referring Medicare beneficiaries from the Miami-Dade state court system to Greater Miami...

February 13, 2018

Detroit-area doctor Mahmoud Rahim was sentenced to 72 months in prison and ordered to forfeit roughly $1.7 million for his role in a $10.4 million conspiracy to defraud the Medicare program. According to the evidence presented at trial, Rahim accepted kickbacks in exchange for referring Medicare patients for electromyogram tests, some of which were unnecessary, and physical therapy performed by unlicensed individuals. DOJ

January 25, 2018

Primex Clinical Laboratories, LLC agreed to pay $3.5 million to settle claims it violated the False Claims Act and Anti-Kickbacks Statue by paying kickbacks in exchange for laboratory referrals for patient pharmacogenetic testing. The allegations originated by a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former sales reps Don Pyburn and David Choate. They will receive a whistleblower award of $754,000 from the...

Medically Unnecessary Services

Government-funded healthcare programs will only pay for services, supplies or equipment that are reasonable and necessary for the diagnosis or treatment of illness or injury. It can be a violation of the False Claims Act for a provider to bill the Government for healthcare services, supplies or equipment that are not medically reasonable or necessary. Types of Billing Fraud for Unnecessary Medical Services or Procedures Examples of billing for unnecessary...

Tennessee Health Care Executives Charged in Kickback Scheme

By the C|C Whistleblower Lawyer Team The DOJ charged two Tennessee health care executives, John Davis and Brenda Montgomery, for their alleged participation in a $4.6 million Medicare kickback scheme involving durable medical equipment.  Davis is the former CEO of pain management company Comprehensive Pain Specialists (CPS).  Montgomery is the owner of medical equipment company CCC Medical Inc.  See DOJ Press Release. According to the government, from at least 2011...

Whistleblower News From The Inside -- March 28, 2018

By the C|C Whistleblower Lawyer Team Wedbush Charged with Failing to Supervise Stockbroker Involved in Penny-Stock Scam – “L.A.’s biggest stockbrokerage ignored or didn’t properly investigate warning signs that one of its brokers was pushing clients to invest in a pump-and-dump scheme, the Securities and Exchange Commission alleged Tuesday. The commission charged Wedbush Inc., based in downtown Los Angeles, with failing to properly supervise a former broker who it alleges received...

Whistleblower News From The Inside -- March 22, 2018

By the C|C Whistleblower Lawyer Team Maryland healthcare providers settle FCA suit for over $800k — A Baltimore-based hospital and four other healthcare providers have settled allegations that they billed Medicare for two, different and redundant tests for deep vein thrombosis. One of the tests is outdated, and was not actually performed by the providers. USAO Maryland Pennsylvania cardiologist settles FCA suit for $126k — Dr. Vidya Banka has settled allegations that...