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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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July 7, 2022

A hospital in West Virginia, Weirton Medical Center, has agreed to pay $1.5 million to settle allegations of submitting or causing to be submitted claims to Medicare that resulted from an improper financial relationship.  In violation of the Stark Law, Weirton allegedly paid referring physicians compensation based on volume and that exceeded fair market value.  USAO NDWV

July 1, 2022

MCS Advantage, Inc. has agreed to pay $4.2 million in order to resolve allegations of submitted or causing to be submitted false claims to Medicare.  In violation of the Anti-Kickback Statute and False Claims Act, MCS allegedly distributed 1,703 gift cards totaling $42,575 to administrative assistants working under healthcare providers in order to induce referrals of Medicare beneficiaries to its plan.  USAO PR

July 1, 2022

Reliance Medical Systems LLC and its owners Bret Berry and Adam Pike will pay $1 million to resolve allegations of False Claims Act violations by paying doctors to use their medical devices in spinal surgeries. Through its physician-owned distributorships (PODs), Reliance paid physicians for referrals, made false statements, and terminated physicians who didn’t refer enough patients, in one instance offering a surgeon a share of profits after he proved his “loyalty” to the POD. DOJ

June 28, 2022

Fifteen additional doctors affiliated with a kickback scheme involving Rockdale Hospital d/b/a Little River Healthcare, True Health Diagnostics LLC, and/or Boston Heart Diagnostics Corporation, have agreed to pay a cumulative $2.8 million to settle allegations of violating the Anti-Kickback Statute and Stark Law by accepting improper remuneration in exchange for ordering tests from those laboratories.  According to the press release, the government has now recovered over $32 million from settlements with thirty-three doctors, two executives, and one laboratory in connection with this scheme.  USAO EDTX

June 6, 2022

SNAP Diagnostics LLC, along with its founder, Gil Raviv, and vice president, Stephen Burton, will pay a combined $3.925 million to settle allegations of False Claims Act and Anti-Kickback Statute violations. SNAP routinely submitted claims for Medicare and TRICARE patients’ second and third nights of home sleep testing, when patients with private health insurance were routinely billed only for the first night. Additionally, SNAP multiplied copays from senior citizen Medicare beneficiaries, and incentivized physicians to refer their patients for sleep testing services. USAO NDIL

May 18, 2022

Pat Truglia will spend 120 months in prison, forfeit over $9.4 million, and will pay restitution of $33.7 million for conspiring to defraud Medicare, TRICARE, and CHAMPVA, among others, of approximately $50 million through their fraudulent billing scheme. The scheme involved offering, paying, soliciting, and receiving kickback for durable medical equipment—in this case, braces. Truglia and his conspirators obtained DME orders for Medicare and other federal healthcare program beneficiaries by running multiple call centers, which paid kickbacks and bribes to telemedicine companies, who then paid doctors to write medically unnecessary orders. The orders were filled by Truglia’s companies, who then fraudulently billed the healthcare programs. USAO NJ

April 13, 2022

A number of anesthesia entities owned and operated by Care Plus Management, LLC (Care Plus), which itself is owned and operated by doctors Paul D. Weir and John R. Morgan, have agreed to pay $7.2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  A qui tam suit by whistleblower Robert Douglas had alleged that between 2012 and 2016, Care Plus entered into illegal revenue-sharing arrangements with physicians in exchange for patient referrals.  For his contributions to a successful enforcement action, Douglas will receive a $1.3 million share of the settlement.  USAO NDGA

April 12, 2022

Physician Partners of America LLC (PPOA), its founder Rodolfo Gari, and its former chief medical officer Dr. Abraham Rivera, have agreed to pay $24.5 million to settle allegations of violating the Stark Law, False Claims Act, and Financial Institutions Reform, Recovery and Enforcement Act (FIRREA).  The settlement resolved claims by whistleblowers Donald Haight, Dawn Baker, Dr. Harold Cho, Dr. Venus Dookwah-Roberts, and Dr. Michael Lupi, all currently or formerly employed with PPOA.  According to the whistleblowers and the government, PPOA allegedly billed Medicare and Medicaid for medically unnecessary testing, paid illegal kickbacks to its physician employees, and made false statements on a loan from the Paycheck Protection Program.  USAO MDFL

March 31, 2022

Clinical laboratory Radeas LLC has agreed to pay $11.6 million to resolve claims that it submitted false claims to Medicare for medically-unnecessary urine drug tests.  As part of the settlement agreement, Radeas admitted that it regularly performed and billed Medicare for essentially simultaneous presumptive qualitative drug testing and confirmatory quantitative drug testing.  Without physician review of a presumptive test result, the separate, simultaneous confirmatory test was often not necessary.  Radeas also admitted that it paid third-party sales organizations based on the volume of UDT referrals in violation of the Anti-Kickback Statute.  USAO MA

March 30, 2022

Multiple sales representatives of Delaware-based pharmacy, Heritage Therapeutics, LLC have been ordered to forfeit and/or pay fines totaling over $8.7 million after they were found to have paid kickbacks to physicians in exchange for prescribing expensive compounded medications to TRICARE beneficiaries.  Additionally, Heritage and various executives have entered into a settlement agreement to resolve claims under the Anti-Kickback Statute and False Claims Act.  USAO EDPA
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