Anti-Kickback and Stark
This archive displays posts tagged as relevant to the Anti-Kickback Statute and Stark Law.
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February 12, 2020
The operator of Georgia-based durable medical equipment company Wilmington Island Medical Inc. has been sentenced to two years in prison and ordered to pay about $550,000 in restitution for paying kickbacks to doctors and nurse practitioners in exchange for signed orders and then billing those orders to Medicare. The judgment against Patrick Wolfe is part of an ongoing investigation by the Southern District of Georgia to crack down on more than $1.5 billion in losses to Medicare and Medicaid originating from the district. So far a total of thirty-one individuals and companies have been charged. USAO SDGACatch of the Week: Roche and Humana Agree to Settle Kickbacks in the Medicare Advantage Program
Posted 02/9/21
February 4, 2021
Durable medical equipment company Regency, Inc., has agreed to a $20.3 million civil settlement to resolve allegations that, together with its principal Kelly Wolfe, it violated the False Claims Act by creating dozens of front companies to submit over $400 million in false claims to government healthcare programs for the sale of DME that was not medically necessary. Defendants were alleged to have paid unlawful kickbacks to doctors and falsely claimed that those doctors provided telehealth services to the beneficiaries, when in most cases the doctors had no interaction at all with the beneficiaries. Wolfe also pleaded guilty to conspiracy to commit healthcare fraud and will be sentenced at a later date. Former Regency employee Condra Albright will receive 23% of the civil recovery as a whistleblower reward. DOJ; USAO MD FLFebruary 3, 2020
The former CEO of Texas hospice and home health chain the Merida Group, Henry McInnis, has been sentenced to 15 years in prison following his conviction for healthcare fraud and alleged charges. McInnis and his co-conspirator Rondey Mesquias, who was previously sentenced to 20 years in prison, submitted over $150 million in fraudulent Medicare bills between 2009 and 2018 by falsifying medical records and telling thousands of patients with long-term incurable diseases they had less than six months to live in order to enroll the patients in hospice programs for which they were otherwise unqualified. In addition, McInnis directed Merida’s practice of paying physicians bogus “medical director” fees in exchange for those doctors falsely certifying unqualified patients for hospice and home health, as well as paying improper kickbacks to patient recruiters. DOJCatch of the Week: EHR Vendor Athenahealth Settles Kickback Cases Brought by Whistleblowers
Posted 01/29/21
January 28, 2021
Electronic health records vendor athenahealth Inc. will pay $18.25 million to resolve claims brought in two separate whistleblower actions alleging that certain Athena marketing programs provided unlawful remuneration to healthcare providers and others to induce providers to purchase Athena’s EHR systems. Remuneration to current and prospective customers included all-expenses paid trips to sporting, entertainment, and recreational events, as well as cash payments to customers who referred others to Athena. In addition, Athena paid other EHR vendors who referred clients to Athena when they were discontinuing their own EHR products and services. The kickbacks allegedly improperly generated sales for Athena while causing healthcare providers to submit false claims to the federal government for incentive payments related to the adoption and “meaningful use” of Athena’s EHR technology. The whistleblowers, Geordie Sanborn, Cheryl Lovell, and William McKusick, will receive a share of the total settlement that remains to be determined. DOJ; USAO MassTop Ten Whistleblower Awards for 2020
Posted 01/22/21
