Anti-Kickback and Stark
This archive displays posts tagged as relevant to the Anti-Kickback Statute and Stark Law.
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May 4, 2021
After being convicted of running a $11 million healthcare fraud scheme, Brenda Rodriguez, the owner and operator of Texas-based QC Medical Clinic, has been ordered to spend 25 years in prison, followed by 3 years of supervised release. As shown by evidence presented at trial, Rodriguez’s scheme involved paying doctors to approve Medicare beneficiaries for home health services, selling the approvals to various home health providers, and causing the providers to bill Medicare for services that were medically unnecessary, never provided, and/or arose from illegal inducements. USAO SDTXMay 3, 2021
Two medical device distributorships, Medical Designs LLC and Sicage LLC, and their neurosurgeon owner, Wilson Asfora, have agreed to pay $4.4 million to resolve allegations of illegally inducing the use of certain medical devices, submitting false claims to federal healthcare programs for medically unnecessary procedures, and failing to disclose Asfora’s ownership interests or illegal payments made to him. The settlement was not the first involving Asfora; the United States previously settled with Sanford Health for $20.25 million and Medtronic for $9.21 million on similar claims. The whistleblowers in this case, Drs. Carl Dustin Bechtold and Bryan Wellman, will receive a $800,000 share of the settlement proceeds, while the defendants will all be excluded from participating in federal healthcare programs for six years. DOJ; USAO SDApril 30, 2020
CareCloud Health, Inc. has agreed to pay $3.8 million to settle kickback allegations involving sales of its electronic health records (EHR) software products and related services. In a qui tam suit filed by Ada de la Vega, the whistleblower alleged that between 2012 and 2017, CareCloud offered and provided existing clients improper incentives, including cash bonuses and equivalent credits, to recommend their product to prospective clients. For her role in the successful enforcement action, de la Vega will receive a relator’s share of over $800,000. USAO SDFLCatch of the Week: Dozens of Fraudsters Sentenced in Multimillion Dollar Compounding Pharmacy Fraud
Posted 04/30/21
April 29, 2021
Over two dozen defendants who were part of an extensive prescription drug fraud scheme involving Alabama-based Northside Pharmacy d/b/a Global Compounding Pharmacy have been sentenced to prison. The defendants included company executives and managers, prescribers, billers, and sales representatives who, between 2013 and 2016, billed insurers such as Medicare and TRICARE for massive quantities of medically unnecessary prescription drugs. In just that short period of time, the defendants caused insurers to pay nearly $50 million in medically unnecessary claims, with more than $13 million arising from improper payments to prescribers, and more than $8.4 million for prescriptions written out to Global employees themselves. USAO NDALApril 23, 2021
Bobby Rouse, a former executive with Continuum Healthcare LLC, which owned Houston hospital Westbury Community Hospital as well as area mental health centers, was sentenced to ten years in prison following his guilty plea on charges arising from an unlawful kickback scheme. At the direction of Rouse and co-conspirators, Continuum paid kickbacks for the referral of patients to partial hospitalization programs at Continuum facilities, many of whom did not qualify for PHP services. In total, Continuum billed Medicare approximately $189 million for fraudulent PHP services, and Medicaid paid approximately $66 million on those clams. Fourteen individuals have been charged for the fraud. USAO SD TXCatch of the Week: Telemarketer Gets 10 Years in $3.3 Million Telemedicine and Genetic Testing Fraud Scheme
Posted 04/16/21
