Anti-Kickback and Stark

November 26, 2019

Boston Heart Diagnostics Corporation will pay $26.7 million to resolve claims that it paid illegal kickbacks to physicians who referred laboratory tests to the company.  Boston Health provided laboratory testing to hospitals in Texas in exchange for per-test payments from the hospitals.  In order to secure more referrals from the hospitals' doctors for its testing services, Boston Health set up "management service organizations" which made payments to referring physicians.  Although these physician payments were disguised as investment returns, they were actually based on, and were provided in exchange for, the physicans' referrals.  In addition, Boston Heart was alleged to have provided other remuneration to referring physicians, including the provision of in-office dieticians, and to have waived patient co-payments and deductibles.  The settlement resolves two different cases brought by  whistleblowers, who will receive $4.36 million from the settlement.  DOJ

November 20, 2019

The Assistance Fund, a foundation that provided funds for pharmaceutical patient assistance programs, will pay $4 million to resolve claims that it conspired with three manufacturers of multiple sclerosis drugs, Teva, Biogen, and Novartis, to improperly funnel contributions from those companies to patients purchasing drugs from those companies.  USAO MA

November 20, 2019

Louisville, Kentucky hospital Jewish Hospital & St. Mary’s Healthcare Inc. has agreed to pay $10.1 million to resolve allegations that the hospital, doing business as Pharmacy Plus and Pharmacy Plus Specialty, submitted false claims to Medicare for prescription drugs that did not have the required physician order or proof of delivery, for prescription refills that were not reasonable and necessary, or for prescriptions that otherwise did not meet Medicare coverage requirements.  In addition, defendant was alleged to have violated the Anti-Kickback Statute by providing unlawful remuneration to patients in the form of free blood glucose testing supplies and waiver of co-payments and deductibles for insulin.  The case was initiated by a qui tam complaint filed by pharmacist Robert Stone, who will receive $1.85 million from the settlement.  DOJ

November 15, 2019

Compounding pharmacy Midwest Compounders, Inc., and its owner Troy DeLong, agreed to pay $205,000 to resolve allegations that they submitted false claims to Tricare for prescriptions that resulted from unlawful arrangements between the pharmacy and prescribers or marketers, or otherwise overbilled for medically unnecessary dosages or redundant active ingredients.  The allegations were first made in a qui tam case filed by a whistleblower under the False Claims Act.  USAO ND Iowa

November 15, 2019

California healthcare system Sutter Health, its hospital the Sutter Memorial Center Sacramento, and the Sacramento Cardiovascular Surgeons Medical Group, Inc., will pay a total of $43.12 million to resolve allegations that the entities violated the Stark Law and improperly double-billed Medicare.  Specifically, Sutter Memorial will pay $30.5 million to resolve charges of wrongfully billing Medicare for services referred to the hospital by Sac Cardio, with whom the hospital maintained improper financial arrangements that overcompensated the Sac Cardio physicians.  In addition, Sutter will pay $15.12 million to resolve allegations that it paid physicians compensation at rates that exceeded fair market value, leased office space to them at below-market rates, and reimbursed them for expenses at inflated rates.  In addition to the Stark Law violations, the settlement also resolved allegations that Sac Cardio submitted duplicative bills for physician assistant services (Sac Cardio will pay $500,000 to resolve these claims), and allegations that several Sutter ambulatory surgical centers had double-billed Medicare for radiological services that had actually been provided, and billed for, by a separate entity.  DOJ reported that allegations against Sutter Memorial and Sac Cardio were first made in a qui tam lawsuit brought by Laurie Hanvey, who will receive $5.9 million from the settlement, and that Sutter Health self-disclosed other conduct at issue in the settlement. DOJ; USAO ED Cal; USAO ND Cal

November 8, 2019

Lenox Hill Hospital and its corporate parent, Northwell Health, Inc., have agreed to pay $12.3 million for violating the Stark Law and False Claims Act in submissions to Medicare.  From 2013 to 2018, Lenox Hill paid the chair of its urology department, Dr. David Samadi, a salary and bonus that improperly took into account the value of his referrals and grossly exceeded fair market value.  In an effort to maximize revenue-generating surgeries, Samadi was repeatedly scheduled to perform overlapping surgeries, leaving patients with unsupervised medical residents in violation of both hospital and Medicare rules.  The department also billed Medicare for minor procedures performed in operating rooms with an unnecessarily full operating room staff.  USAO SDNY

November 8, 2019

In the eleventh settlement involving the multi-state OK Compounding Pharmacy fraud scheme, podiatrist Jonathan Moore of Kentucky has agreed to pay $65,404 for the role he played in defrauding federal healthcare programs.  In exchange for illegal kickbacks disguised as “medical director fees,” Dr. Moore allegedly prescribed medically unnecessary compounded pain creams to patients, many of whom were insured by Medicare and TRICARE.  USAO NDOK

November 7, 2019

Medical device manufacturer Life Spine Inc. has agreed to pay $5.5 million to settle fraud allegations stemming from a qui tam suit, with founder and CEO Michael Butler agreeing pay another $375,000, and VP of business development Richard Greiber agreeing to pay another $115,000.  As part of the settlement, the defendants admitted to paying kickbacks to surgeons and entities between 2012 and 2018 in exchange for their use of Life Spine’s spinal implants, devices, and equipment.  USAO SDNY