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Anti-Kickback and Stark

This archive displays posts tagged as relevant to the Anti-Kickback Statute and Stark Law.

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April 27, 2020

North Carolina based clinical laboratory Genova Diagnostics Inc. will pay up to $43 million to resolve a lawsuit brought by whistleblower Darryl Landis, who will receive up to $6 million.  The laboratory allegedly billed Medicare, TRICARE, and other government healthcare programs for IgG allergen, “NutrEval,” and “GI Effects” lab tests that were not medically necessary, and also paid unlawful compensation to three phlebotomy vendors in violation of the Stark Law  The settlement amount consists of the forfeiture of $17 million in claim funds held in suspension by Medicare and TRICARE, as well as an additional $26 million to be paid based on certain financial contingencies over the next five years.  DOJ; USAO WD NC

April 6, 2020

Following a $7.1 million settlement with seven co-defendants in October 2019, a chiropractor in New Jersey who allegedly concocted the scheme to bill Medicare for medically unnecessary injections and knee braces has agreed to pay $2 million to resolve his liability.  A critical analysis of Medicare claims data revealed that while treating for osteoarthritis, David Podell caused his clinic and seven Osteo Relief Institutes to bill Medicare for viscosupplementation injections—gel-like fluids injected into the knee that act as lubricant—as well as custom knee braces for beneficiaries who did not need them.  Additionally, the claims for the custom knee braces were tainted by illegal kickbacks that Podell solicited and received from the manufacturer.  DOJ; USAO MN

Charges Filed in Shameful COVID-19 and Genetic-Cancer-Screening Test Scam

Posted  04/3/20
doctor-mask
Erik Santos of Braselton, Georgia had run a fraudulent genetic cancer-screening-test scheme for months, then spotted an opportunity capitalize on fear surrounding COVID-19.  According to the criminal complaint, Santos targeted elderly persons to determine if they met certain eligibility requirements for testing under government health-care programs.  He passed the information along to co-conspirator testing...

The Missing Ventilator Stockpile Was Not Inevitable

Posted  04/3/20
By Sarah “Poppy” Alexander
Hospital Building Sign
The coronavirus crisis has been a crash course for the general public in how lifesaving ventilators work.  But the federal government has long known how crucial they are and how important it is to be able to stockpile sufficient numbers.  Five years ago, the government tried to plan ahead by commissioning the design and production of a low-cost ventilator to build up public and private stores in case an...

April 2, 2020

FPR Specialty Pharmacy LLC and Mead Square Pharmacy, Inc., along with owners Christopher Casey and William Rue, have agreed to pay $426,000 to settle a whistleblower-brought case alleging violations of the Anti-Kickback Statute and False Claims Act in connection with a compounded prescription analgesic cream called Focused Pain Relief.  As part of the settlement, the defendants admitted that from 2011 to 2015, they sold prescription drugs to patients in states they were not licensed to sell in, failed to charge mandatory co-pays to beneficiaries of various federal healthcare programs, and paid sales agents to solicit physicians to prescribe the cream.  USAO SDNY

April 1, 2020

A physician’s assistant in Louisiana, Stephen Honeycutt, has agreed to pay $620,500 for accepting illegal kickbacks from OK Compounding, LLC, which has been involved in multiple enforcement actions of a similar nature across the country.  Over a period of about six months in 2013, Honeycutt prescribed expensive compounded pain creams to patients, many of whom were Medicare and TRICARE beneficiaries, in exchange for kickbacks disguised as medical director fees.  USAO NDOK

March 20, 2020

A doctor in Florida has paid the United States $850,000 to settle claims of violating the Anti-Kickback and False Claims Acts.  In exchange for prescribing a powerful but highly addictive fentanyl spray, Subsys, to her patients, Dr. Parveen Khanna allegedly took illegal kickbacks from manufacturer Insys Pharmaceuticals, Inc that were disguised as speaker fees, then submitted claims for reimbursement to Medicare and TRICARE in violation of program rules prohibiting payment for kickback-induced services.  USAO MDFL

March 4, 2020

STG Healthcare of Atlanta, Inc. and senior executives Paschal Gilley and Mathew Gilley have agreed to resolve fraud allegations by paying $1.75 million.  The case against the hospice was launched by two former employees, Serita Samuel and Miranda Eskridge, who alleged in a qui tam suit that STG Healthcare submitted false claims to Medicare and Medicaid that arose from illegal payments to so-called back-up medical directors, and that were on behalf of patients who were not terminally ill and thus ineligible for palliative care.  GA AG; USAO NDGA

February 28, 2020

Sanofi-Aventis U.S., LLC has agreed to pay $11.85 million to resolve allegations of paying kickbacks to Medicare patients in connection with a multiple sclerosis drug called Lemtrada.  According to the press release, Lemtrada costs nearly $100,000 per patient per year, and Medicare co-pays can be many thousands of dollars per year.  In order to break down barriers to access for Medicare patients, Sanofi allegedly provided kickbacks to them via payments to a purportedly independent charitable foundation, The Assistance Fund (TAF), which helps covers the co-pays in violation of the Anti-Kickback Statute.  The scheme was reported by a partnership formed by Sanofi's predecessor, Genzyme Corporation, which will receive about $2.7 million for their role in the case.  USAO MA

First Circuit Revives Whistleblower Suit Against PharMerica, Rejecting Public Disclosure Challenge

Posted  02/28/20
boston-first-circuit-building
Rejecting an argument that only a fraudster could love, the First Circuit Court of Appeals revived a whistleblower’s lawsuit and rightly recognized that whistleblowers can have “direct” knowledge of fraud even if they did not themselves participate in the fraud. In United States ex rel. Banigan & Templin, et al. v. PharMerica, Inc., the First Circuit interpreted the so-called “original source” provision of...
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