Anti-Kickback and Stark Archives - Page 15 of 61

Top Ten Healthcare Fraud Recoveries of 2020

Posted 01/5/21

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, FCPA, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

December 21, 2020

Substance abuse treatment provider A.R.E.B.A.-CASRIEL, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (“ACI”) and its owner, Steven Yohay, agreed to pay a total of $6 million to resolve federal and New York state claims that they defrauded Medicaid including through the payment of kickbacks and other fraudulent conduct in connection with the enrollment of Medicaid beneficiaries into ACI’s inpatient treatment program. Defendants allegedly employed drivers who were compensated in part based on the number of patients they recruited, to target homeless individuals to enroll in ACI’s inpatient treatment program by offering food, cash, and money to purchase drugs, and/or alcohol. In addition, ACI unlawfully paid a patient recruiter, and enrolled Medicaid patients who had not been evaluated by a qualified healthcare professional, including by copying a physician’s signature. The government’s investigation was initiated by a whistleblower complaint filed by a former employee, who will receive an undisclosed amount of the settlement. USAO SDNY; NY

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 18, 2020

Texas Heart Hospital of the Southwest LLP and its affiliate THHBP Management Company LLC will pay $48 million to resolve claims brought in a whistleblower suit by two of the hospitals’ physicians alleging that the defendants violated the False Claims Act, Stark Law, and Anti-Kickback Statute. Agreements between the hospital and its physician-owners required the doctors to have 48 patient-contacts a year in order to maintain their ownership interests. The U.S. did not intervene in the action; the whistleblowers, Dr. Mitchell Magee and Dr. Todd Dewey, will collectively receive $13.92 million, 29% of the total settlement, as a whistleblower reward. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

December 17, 2020

Pharmaceutical company Biogen Inc. agreed to pay $22 million, and specialty pharmacy Advanced Care Scripts agreed to pay $1.4 million, to resolve claims that they conspired to use two foundations, the Chronic Disease Fund and The Assistance Fund, as conduits to pay Medicare co-payments for patients taking Biogen’s MS drugs, Avonex and Tysabri, in violation of the Anti-Kickback Statute. The government alleged that Biogen coordinated with ACS to time its payments to the foundations and direct its money to cover co-pay costs for patients using its drugs. DOJ; USAO MA

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Pharma Fraud,

December 10, 2020

Teresita Lumanas Alquero, the former owner of Providence Home Health and Providence Hospice, agreed to pay $1.05 million to resolve False Claims Act claims first made in an action brought by a whistleblower that she paid improper kickbacks to the medical director of Providence. The payments exceeded fair market value and were intended to induce the doctor to refer Medicare patients to Providence. USAO SDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Home Health and Hospice, Whistleblower Case,

December 2, 2020

The owner and operator of Atlanta-based Elite Homecare has been sentenced to over five years in prison and ordered to pay $999,999 in restitution for defrauding Medicaid of nearly $1 million. As a provider under the Georgia Pediatric Program (GAPP)—an in-home nursing program for Medicaid-eligible children with severe physical and cognitive disabilities—Diandra Bankhead allegedly submitted thousands of claims for services that were fraudulent in a myriad of ways. Some of the claims falsely represented that employees provided more than 24 hours of services in a given day to multiple children simultaneously (including to children whose families had not retained Elite, and by RNs who did not know their credentials were being used), while other claims contained fraudulent credentialing information and fraudulent supporting documentation, or were upcoded to induce higher payments from Medicaid. Additionally, Bankhead allegedly “sold” information about twenty of Elite’s former clients to another Atlanta-based home health provider in exchange for a percentage of the reimbursements from Medicaid. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud, Provider Fraud, Upcoding,

November 24, 2020

Florida-based Doctor’s Choice Home Care, Inc. and its founders and former top executives Timothy Beach and Stuart Christensen have agreed to pay a combined $5.15 million to settle qui tam suits filed under the False Claims Act by former employees—one by Corina Herbold, and the other by Sara Billings, Misty Sykes, and Marina Eschoyez-Quiroga. In violation of the Anti-Kickback Statute and the Stark Law, the home health agency had allegedly set up sham medical director agreements with physicians to pay them for referrals, linked employee bonuses to referrals made by physician spouses, and provided medically unnecessary services to Medicare patients in order to avoid decreased reimbursements triggered by fewer than five skilled service visits. To settle the allegations, Doctor’s Choice will pay over $4.5 million, while Beach and Christensen will pay $647,000 each. Billings, Sykes, and Eschoyez-Quiroga will jointly receive $145,000 of the settlement proceeds; Herbold’s share has yet to be determined. DOJ; USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Whistleblower Case, Whistleblower Rewards,

October 29, 2020

Medtronic has agreed to pay over $9.2 million to resolve allegations of violating the False Claims Act and CMS’s Open Payments Program by paying kickbacks to a South Dakota-based neurosurgeon, Wilson Asfora, M.D., in order to induce sales of its SynchroMed II implantable intrathecal infusion pumps. According to the government, Medtronic allegedly sponsored nine years’ worth of events at a restaurant owned by Asfora, and to which Asfora would invite his acquaintances, business partners, trusted colleagues, and referral sources. For his role in the kickback scheme, Asfora has been named in a separate FCA lawsuit, which the United States joined last November. USAO SD

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Medicare,

October 21, 2020

Purdue Pharma LP agreed to criminal fines and forfeitures totaling $5.544 billion following its guilty plea on charges arising from its manufacture and sale of opioid products. Purdue falsely represented to the DEA that they maintained an effective anti-diversion program while continuing to market opioid products to healthcare providers that it had reason to believe were diverting opioids, aided and abetted the dispensing of opioids without a legitimate medical purpose, paid doctors to induce them to prescribe Purdue’s products, and paid an EHR company to boost the presence of Purdue’s products on the EHR system. Purdue will receive a credit of up to $1.775 billion based on its prior settlements with state and local entities. In addition to the criminal fines and forfeitures, a civil settlement provides the U.S. with an allowed claim of $2.8 billion to resolve claims that the company caused the submission of false claims to federal healthcare programs. Individual members of the Sackler family, which owns Purdue, separately agreed to pay $225 million to resolve claims arising from their approval of a marketing program aimed at extreme high-volume prescribers and their transfer of assets into Sackler family holding companies and trusts. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Lack of Medical Necessity, Pharma Fraud,

October 14, 2020

Medical device maker Merit Medical Systems Inc. will pay $18 million to resolve claims first brought by a whistleblower under the False Claims Act that the company paid unlawful kickbacks to doctors and hospitals to induce them to use MMSI’s EmboSphere and QuadraSphere devices for embolization procedures. MMSI was alleged to have offered hospitals and providers with millions of dollars in free advertising assistance, “educational” grants, and other services based on the providers’ past sales and to induce future sales. The whistleblower, Charles J. Wolf, M.D., who will receive $2.65 million, was the Chief Compliance Officer for the company; according to DOJ, he repeatedly warned MMSI that its practices violated the Anti-Kickback Statue. DOJ; USAO NJ; NC AG

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

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