Anti-Kickback and Stark

February 15, 2018

New York announced the arrest and indictment of, as well as a civil asset forfeiture action against, Arkady Goldin, 39, of Brooklyn, and Value Pharmacy, Inc. ("Value"), for allegedly defrauding the New York State Medicaid program out of millions of dollars. Goldin, an owner of Value, is charged with Grand Larceny in the First Degree and other crimes for having allegedly paid kickbacks to a hospital employee for the referral of prescriptions for costly cancer medications. Additionally, prosecutors allege that Value billed Medicaid for over a million dollars of prescription medication it did not have in stock to dispense. The Attorney General’s Medicaid Fraud Control Unit ("MFCU"), also filed an asset forfeiture and civil recovery action against Goldin, Value, and Goldin’s co-owners seeking over $8.7 million in damages and penalties, alleging that Value’s owners made millions from these schemes that they funneled through shell companies to purchase personal expenses such as travel, luxury cars, and a high-end country club membership. NY

January 4, 2018

Kim Ricard was sentenced to 51 months in prison and to pay roughly $2 million in restitution for her involvement in a $2 million home health kickback scheme carried out through a New Orleans area home health agency. DOJ

December 20, 2017

Maryland-based pharmaceutical company United Therapeutics Corporation agreed to pay $210 million to resolve claims it violated the False Claims Act and Anti-Kickback Statute by using a foundation as a conduit to pay the copays of Medicare patients taking the company's pulmonary arterial hypertension drugs. The government charged that covering the copays was prohibited remuneration used to induce Medicare patients to purchase the company’s products. DOJ

December 19, 2017

Two physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million to settle charges of violating the False Claims Act and Anti-Kickback Statute for allegedly receiving kickbacks in exchange for patient referrals to hospitals owned by the now-defunct Health Management Associates. Dallas-based EmCare agreed to pay $29.6 million to resolve allegations it received remuneration from HMA to recommend patients be admitted to HMA hospitals on an inpatient basis when the patients should have been treated on an outpatient basis. In a separate settlement, Pennsylvania-based Physician's Alliance agreed to pay $4 million for allegedly accepting illegal remuneration from HMA to refer patients to two HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center. The allegations originated in whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Drs. Thomas Mason and Stephen Folstad brought the qui tam suit against EmCare and will receive a whistleblower award of roughly $6.2 million from the proceeds of the government's recovery. Former HMA hospital executives George E. Miller and Michael J. Metts brought the qui tam suit against Physician's Alliance and will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ

December 14, 2017

Texas-based DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with severe kidney disease, agreed to pay $63.7 million to resolve charges of violating the False Claims Act by billing Medicare for prescription medications never shipped, shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent. The settlement also resolves allegations that DaVita paid financial inducements to Medicare beneficiaries in violation of the Anti-Kickback Statute. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by two former DaVita employees Patsy Gallian and Monique Jones. The whistleblowers will receive an award of $2.1 million from the proceeds of the government's recovery. DOJ