Anti-Kickback and Stark

February 28, 2018

Rafael Arias, the owner of numerous Miami-area home health agencies, was sentenced to 240 months in prison and pay $66.4 million in restitution for his role in a $66 million conspiracy to defraud the Medicare program. As part of his guilty plea, Arias admitted recruiting nominee owners to falsely and fraudulently represent themselves as the agencies’ owners to hide his identity and ownership interest. Arias and his co-conspirators paid illegal bribes and kickbacks to patient recruiters to refer patients to these agencies, and submitted false and fraudulent home health care claims to Medicare for beneficiaries who, in many cases, did not qualify or for whom the services were never provided. DOJ

February 22, 2018

Samuel Konell was sentenced to 60 months in prison and pay roughly $10 million for his role in a $63 million health care fraud scheme involving now-defunct Greater Miami Behavioral Healthcare Center Inc. which purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness. Konell admitted he received kickbacks and/or bribes in return for referring Medicare beneficiaries from the Miami-Dade state court system to Greater Miami to serve as patients. He admitted he coordinated with criminal defendants in the state court system to obtain court orders for mental health treatment in lieu of incarceration so that he could refer those individuals to Greater Miami to serve as patients in return for kickbacks and/or bribes. Konell further admitted that he did so knowing that certain of those individuals were not mentally ill or otherwise did not meet the criteria for PHP treatment. DOJ

February 13, 2018

Detroit-area doctor Mahmoud Rahim was sentenced to 72 months in prison and ordered to forfeit roughly $1.7 million for his role in a $10.4 million conspiracy to defraud the Medicare program. According to the evidence presented at trial, Rahim accepted kickbacks in exchange for referring Medicare patients for electromyogram tests, some of which were unnecessary, and physical therapy performed by unlicensed individuals. DOJ

January 25, 2018

Primex Clinical Laboratories, LLC agreed to pay $3.5 million to settle claims it violated the False Claims Act and Anti-Kickbacks Statue by paying kickbacks in exchange for laboratory referrals for patient pharmacogenetic testing. The allegations originated by a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former sales reps Don Pyburn and David Choate. They will receive a whistleblower award of $754,000 from the proceeds of the government’s recovery. DOJ (NDTX)

January 23, 2018

Drs. Aytac Apaydin and Stephen Worsham, urologists based in Northern California who own Salinas Valley Urology Associates and formerly owned Advance Radiation Oncology Center, will pay roughly $1 million to settle claims they violated the False Claims Act by submitting claims to Medicare for image guided radiation therapy (IGRT) that was referred and billed in violation of the physician self-referral law (the “Stark Law”) and the Anti-Kickback Statute. DOJ