Anti-Kickback and Stark Archives

August 16, 2019

2d Chance PLLC, a Kentucky-based substance abuse center, will pay $200,494 to resolve allegations under the False Claims Act that it entered into an arrangement with Compliance Advantage, LLC, a toxicology lab, whereby 2d Chance referred patients to Compliance Advantage for complex drug testing, and Compliance Advantage provided a no-cost chemistry analyzer to 2d Chance, allowing 2d Chance to perform some urine testing at its site and bill Medicaid for those services. The financial arrangement violated the Anti-Kickback Statute. EDKY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

August 15, 2019

Alabama-based Baldwin Bone & Joint, P.C. (BB&J) has settled a False Claims Act action for $1.2 million. According to the whistleblower who initiated the action, former BB&J employee John Seddon, BB&J submitted claims to Medicare and TRICARE for physical therapy services performed by unauthorized providers, and compensated shareholder physicians based on the volume of physicians’ internal referrals. As part of the settlement, Seddon will receive a $200,000 relator’s share. USAO SDAL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

August 1, 2019

Tennessee-based telemarketer Scott Roix and his companies have agreed to pay $2.5 million to settle two whistleblowers’ False Claims suit alleging the submission of false claims to Medicare, TRICARE, and other federal health benefit programs. Roix and his companies allegedly procured fraudulent insurance information from patients around the country in order to arrange prescriptions for medically unnecessary pain creams; they then sold these prescriptions to pharmacies, labeling proceeds as earned through marketing services. The whistleblowers in this case, Jennifer Silva and Jessica Robertson, will receive $287,500 for revealing the fraudulent scheme. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted 07/26/19

Laboratory sample vial lying on procedure coding form

Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states. CPS shut down in 2018 with little warning to patients and employees. On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in...

Tagged in: Anti-Kickback and Stark, Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,

Question of the Week — Is DOJ’s Blockbuster $1.4 Billion Opioid Settlement Just the Tip of the Iceberg?

Posted 07/12/19

Pill container spilled over with pills fallen out.

On July 11, DOJ announced a record-breaking $1.4 billion settlement with Reckitt Benckiser Group plc (RB Group) over allegations that its former subsidiary Indivior Inc. inflated prescriptions of its opioid-withdrawal drug Suboxone through numerous unestablished representations about the drug’s safety and addictiveness. The settlement resolves RB Group’s potential civil and criminal liability, but Indivior still...

Tagged in: Anti-Kickback and Stark, FDA Fraud, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Provider Fraud,

July 8, 2019

Anthony Camillo, the owner of Illinois-based Allegiance Medical Laboratory and AMS Medical Laboratory, has been sentenced to 2.5 years in prison and ordered to pay $3.5 million in restitution for defrauding Medicare and Medicaid. According to the DOJ, Camillo paid Missouri-based marketers between $150-$200 for urine and saliva samples sent to his labs. His conduct incentivized other fraudulent conduct, including medically unnecessary testing of disabled and elderly patients living in residential care facilities, and the use of doctors’ names on test orders without the doctors’ knowledge. USAO EDMO

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare,

July 5, 2019

A New York doctor is the latest defendant in a widespread OK Compounding pharmacy fraud scheme to settle with the government. From 2014 to 2015, Dr. George Lehner allegedly prescribed compounded pain creams for his Medicare patients in exchange for an hourly “medical director fee” by OK Compounding LLC. To settle the case against him, Lehner will pay about $130,000. USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

June 26, 2019

A patient recruiter in Michigan has been sentenced to 5 years in prison and ordered to pay $1.5 million in restitution for taking part in a three-year scheme to defraud Medicare. Defendant Sophia Eggleston had allegedly solicited and received kickbacks in exchange for her referrals, causing Medicare to pay $1.5 million to a home health agency connected to the fraud scheme. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medicare,

June 18, 2019

Nevada Heart & Vascular Center has agreed to pay $2.5 million to settle allegations that it accepted kickbacks from genetic testing companies, Natural Molecular Testing Corp. and Iverson Genetic Diagnostics, Inc., in exchange for referrals of Medicare patients. The alleged violations of the Anti-Kickback Statute and False Claims Act occurred for nearly a year in 2012. USAO NV

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

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 Glazer’s clinic for home health services that were allegedly medically unnecessary. DOJ; USAO CDCA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity,

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