Anti-Kickback and Stark

April 9, 2019

A number of telemedicine and durable medical equipment companies, the principals of those companies, and three healthcare providers, were charged with submitting over $1.7 billion in false claims in a scheme to pay unlawful kickbacks and bribes from DME companies in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for medically unnecessary DME including back, shoulder, wrist and knee braces.  DOJ; USAO MD FL; USAO NJ; USAO SC.

April 4, 2019

Jazz Pharmaceuticals (Jazz), Lundbeck LLC (Lundbeck), and Alexion Pharmaceuticals Inc. (Alexion) will pay a total of $122.6 million to settle allegations they violated the False Claims Act by having improper kickback schemes and for illegally paying Medicare and Civilian Health and Medical Program (ChampVA) copays for their own products. The Anti-Kickback Statute prohibits a pharmaceutical company from offering or paying, directly or indirectly, any remuneration — which includes money or any other thing of value — to induce Medicare or ChampVA patients to purchase the company’s drugs. This prohibition extends to the payment of patients’ copay obligations. Under the terms of the settlement, Jazz agreed to pay $57 million, Lundbeck agreed to pay $52.6 million, and Alexion will be paying $13 million. DOJ  

March 21, 2019

Nonprofit healthcare organization MedStar Health Inc. has agreed to pay $35 million to the United States to settle two qui tam lawsuits alleging violations of the False Claims Act at two of its hospitals in Baltimore. According to the first complaint, filed by three cardiac surgeons, MedStar paid illegal remuneration to MidAtlantic Cardiovascular Associates (MACVA) to induce referrals of Medicare patients. The second complaint, filed by former patients, alleged that while employed by MedStar, former MACVA employee Dr. John Wang engaged in a pattern of performing and billing for medically unnecessary cardiac stent procedures. DOJ

March 11, 2019

Medical device manufacturer Covidien LP will pay $20 million to resolve False Claims Act cases initiated by three whistleblowers alleging that Covidien violated the Anti-Kickback Statute by providing remuneration to healthcare providers in California and Florida.  Covidien markets radiofrequency ablation catheters to providers including vein surgery practices for use in procedures for the treatment of varicose veins and underlying conditions, and allegedly provided its customers with substantial assistance in connection with marketing vein screening and related services in order to increase demand for such services and therefore induce purchases of Covidien's vein ablation products.  Covidien will pay $17.5 million to the United States; $1.5 million to California; and $1 million to Florida.  Two whistleblowers who were sales managers for Covidien, Erin Hayes and Richard Ponder, will share a $3.1 million whistleblower reward.  The settlement also resolves claims by whistleblower Shawnea Howerton, a former employee of one of Covidien's customers.  DOJ; USAO NDCal; FL

February 28, 2019

A former employee within the Wayne County Adult Services division of the Michigan Department of Health and Human Services has been charged with defrauding the state's Medicaid program. As an Independent Living Services Specialist, Eliza Yulonda Ijames was responsible for approving Medicaid beneficiaries for home health services. In violation of anti-kickback rules, however, she used her position to refer clients to agencies with which she had an improper financial relationship. AG MI

February 27, 2019

A Florida-based home health agency owner, Alexander Ros Lazo, has been sentenced to over 7 years in prison and ordered to pay $8.6 million in restitution for defrauding Medicare. In exchange for the referral of Medicare beneficiaries to his company, T.L.C. Health Services, Dos Lazo paid kickbacks to co-conspirators and caused his co-conspirators to submit billing for physical therapy services performed by an unlicensed practitioner, Misleady Ibarra. Along with Ros Lazo. Ibarra has been sentenced to 2 years in prison; the amount she will pay in restitution is still to be determined. DOJ

February 22, 2019

Marketers, doctors, lawyers, and medical service provider defendants were sentenced this week for their roles in a multi-million dollar California worker's compensation fraud scheme in the San Diego area.  The defendants recruited patients and referred them to co-defendant attorneys to file fraudulent claims on their behalf and medical providers who performed often unnecessary and painful medical procedures for which they would then bill insurers including California Workers' Compensation.  Ronald Grusd, a doctor who owned a diagnostic imaging company, was sentenced to 10 years in prison and ordered to forfeit $1.3 million.  Fermin Iglesias, who worked as a patient capper, was sentenced to 5 years in prison and ordered to forfeit $1 million. Julian Garcia, who provided services to assist the referrals and kickbacks, was sentenced to three years in prison.  Jennifer Louise White, who marketed to providers in the network, was sentenced to two years in prison.  Sean O'Keefe, an attorney who filed fraudulent claims on behalf of patients, was sentenced to 13 months in prison and ordered to forfeit $300,000.  Steven Rigler, a chiropractor, was sentenced to six months in prison.  USAO SD Cal.