Anti-Kickback and Stark

Bay Sleep Clinic - Healthcare Fraud/Kickbacks ($2.6 million)

Constantine Cannon represented a whistleblower under the False Claims Act case alleging Bay Sleep Clinic billed Medicare for sleep studies by unlicensed technicians and paid kickbacks to doctors for patient referrals.  In December 2016, the company agreed to pay $2.6 million to settle the matter.  Our client received a whistleblower award of roughly 21% of the government’s recovery.  Read more -- SF Gate, DOJ, PR Newswire, CC.

September 14, 2016

Healthmark Investment Trust, partial owner of Florida-based compound pharmacy QMedRx, agreed to pay $7.75 million to resolve allegations QMedRx violated the False Claims Act by billing the federal healthcare programs for prescriptions tainted within the meaning of the Anti-Kickback Statute.  The government is still pursuing penalties and fines from other owners and participants within QMedRx.  DOJ (MDFL)

September 14, 2016

Romy Macasaet and his Illinois-based home health care company Home Bound Healthcare, Inc. agreed to plead guilty and pay $6.8 million to resolve charges of violating the False Claims Act and the Anti-Kickback Statute by paying kickbacks to medical directors to obtain referrals of Medicare beneficiaries to his company, which was one of the largest home health care and hospice companies in Illinois.  Macasaet acknowledged that he retained and paid medical directors a monthly fee solely for the purpose of obtaining patient referrals and not for medical services, and that he used medical director agreements to conceal the payment of kickbacks.  As part of the settlement, Macasaet agreed to divest his ownership interest in Home Bound.  DOJ (NDIL)

September 9, 2016

Los Angeles nursing home Westlake Convalescent Hospital and two physicians who worked there, Dr. Jasvant Modi and his wife Dr. Meera Modi, agreed to pay $3,563,140 to resolve charges they violated the False Claims Act by participating in a scheme to improperly transfer patients recruited from the “Skid Row” district to a hospital for medically unnecessary services, and then transfer the patients from the hospital to the nursing home for medically unnecessary stays.  According to the government, Westlake paid illegal kickbacks to a “care consortium” on Skid Row in exchange for patient referrals to Westlake.  Jasvant Modi allegedly readmitted patients from Westlake to the now-closed Temple Community Hospital and then back to Westlake to extend the patients’ Medicare-covered stays at Westlake, knowing the patients did not require further services at either facility.  Meera Modi allegedly signed medical orders for non-payable services for these same patients. Westlake allegedly billed Medicare and Medi-Cal for medically unnecessary services provided to these patients.  The allegations originated in a whistleblower lawsuit brought by former Westlake employee Ricardo Gonzales under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $534,471 from the proceeds of the government's recovery.  DOJ (CDCA)

August 5, 2016

A series of anesthesia businesses collectively known as Sweet Dreams Nurse Anesthesia agreed to pay roughly $1 million to settle charges they violated the False Claims Act, Anti-Kickback Statute and Georgia False Medicaid Claims Act by paying unlawful kickbacks to health care providers for referrals.  According to the government, one alleged scheme involved Sweet Dreams’ provision of free anesthesia drugs to ambulatory surgery centers (ASCs) in exchange for granting Sweet Dreams an exclusive contract to provide anesthesia services at those ASCs.  A second alleged scheme allegedly involved the agreement of an affiliate of Sweet Dreams to fund the construction of an ASC in exchange for contracts for Sweet Dreams’ selection as the exclusive anesthesia provider.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Adam Nauss.  He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (MDGA)

July 28, 2016

South Carolina hospital Lexington County Health Services District Inc. (d/b/a Lexington Medical Center) agreed to pay $17 million to resolve allegations it violated the False Claims Act and the Physician Self-Referral Law (known as the Stark Law) by maintaining improper financial arrangements with 28 physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Lexington Medical Center physician Dr. David Hammett.  He will receive a whistleblower award of roughly $4.5 million from the proceeds of the government’s recovery.  Whistleblower Insider

July 25, 2016

Florida announced the arrests of three individuals for operating a $1 billion Medicare and Medicaid fraud scheme involving numerous Miami-based health care providers. Attorney General Bondi’s MFCU, as part of the HEAT Strike Force, assisted in identifying more than $100 million of Medicaid fraud in connection to this scheme. According to the indictment, Philip Esformes, 47, operated a network of more than 30 skilled nursing homes and assisted living facilities that gave access to thousands of Medicare and Medicaid beneficiaries. Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility. However, Esformes and co-conspirators admitted the beneficiaries to Esformes Network facilities, and received medically unnecessary services billed to Medicare and Medicaid. The defendants also allegedly received kickbacks by steering the beneficiaries to other health care providers, including community mental health centers and home health care providers, who also performed medically unnecessary treatments billed to Medicare and Medicaid. In order to hide the kickbacks from law enforcement, the kickbacks were often paid in cash, or were disguised as payments to charitable donations, payments for services and sham lease payments. FL

July 18, 2016

Bristol-Myers Squibb agreed to a $30 million settlement to resolve allegations of unlawful kickbacks to physicians in the marketing of Pravachol and other drugs.  The claims were made in a whistleblower suit filed under the California Insurance Frauds Prevention Act by three former Bristol-Myers sales representatives, who will receive a share of the settlement.  CA