Anti-Kickback and Stark

June 30, 2016

Florida cardiologist Dr. Asad Qamar and his practice, the Institute of Cardiovascular Excellence (ICE), will pay $2 million plus release any claim to $5.3 million in suspended Medicare funds, to settle charges they violated the False Claims Act by billing for medically unnecessary procedures and paying kickbacks to patients by waiving Medicare copayments irrespective of financial hardship.  By waiving the required copayments, Dr. Qamar and ICE induced patients to agree to unnecessary and invasive procedures and other services.  Dr. Qamar’s and ICE’s illegal conduct made Dr. Qamar the highest paid Medicare cardiologist in the country in 2012 and 2013.  The allegations originated in two whistleblower lawsuits filed by Dr. Robert A. Green and Ms. Holly A. Taylor under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $1.3 million from the proceeds of the government's recovery.  DOJ

June 29, 2016

Minneapolis-based Cardiovascular Systems, Inc. (CSI) agreed to pay $8 million to resolve allegations that it violated the False Claims Act by paying illegal kickbacks to induce physicians to use the company’s medical devices.  According to the government, CSI developed and distributed marketing materials to promote physicians using CSI’s devices to referring physicians; coordinated meetings between these physicians and referring physicians; and developed and implemented business expansion plans for the physicians.  The government alleged that CSI engaged in these activities to induce doctors to begin to use or continue to use CSI’s devices.  The allegations originated in whistleblower lawsuit filed by former CSI employee Travis Thams under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award from a share of the government's recovery.  DOJ (WDNC)

June 23, 2016

New Jersey osteopathic physician Vincent Destasio pleaded guilty to accepting thousands of dollars in exchange for patient referrals to two lab companies that performed blood and DNA testing.  DOJ (DNJ)

June 9, 2016

Raleigh, North Carolina-based specialty pharmacy Salix Pharmaceuticals, Inc., which sells products used to treat various gastroenterology conditions, agreed to pay $54 million to settle charges it violated the federal Anti-Kickback Statute and False Claims Act by using its “speaker programs” as a mechanism to pay kickbacks to doctors to induce them to prescribe Salix drugs and medical devices.  Specifically, the government alleged Salix held sham speaker programs, frequently at high-end restaurants, where doctors were paid substantial honoraria purportedly to educate other doctors about a Salix product, but in reality spent little or no time discussing the product.  $16,578,000 of the settlement amount will go to the Medicaid programs of different states including Ohio.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive a yet-to-be-determined award from the proceeds of the government's recovery.  DOJ (SDNY), OH

June 1, 2016

Dr. Jonathan Oppenheimer, former owner and CEO of Nashville drug testing laboratory Prost-Data, Inc. (d/b/a OURLab), OPKO Health, Inc., and OPKO Lab, have agreed to pay $9.35 million to resolve charges they violated the False Claims Act by providing illegal kickbacks in exchange for business.  According to the government, Dr. Oppenheimer and OURLab made donations toward electronic health records (EHR) systems purchased by their client physician practices that fell outside the restrictions set forth in the Anti-Kickback Statute EHR safe harbor and the Stark EHR exception.  The allegations originated in a whistleblower lawsuit filed by a former OURLab employee under the qui tam provisions of the False Claims Act.  The whistleblower will receive a whistleblower award of $1.683 million from the proceeds of the government's recovery.  DOJ (MDTE)

May 27, 2016

Carlos Rodriguez Nerey, the owner and president of Miami-area consulting and staffing company Nerey Professional Services Inc., was sentenced to 60 months in prison (and ordered to pay roughly $2.4 million in restitution) for his role in a $2.3 million Medicare fraud scheme.  According to evidence presented at trial, Nerey was involved in a conspiracy to accept kickbacks in return for referring Medicare beneficiaries to Mercy Home Care Inc. and D&D&D Home Health Care Inc. to serve as patients, including those who did not qualify for home health care services.  DOJ

May 20, 2016

New Jersey announced that a chiropractor from Morris County pleaded guilty to taking more than $250,000 in illegal kickbacks from doctors and other individuals in return for referring patients to their practices, clinics and medical imaging centers. Dr. Alexander Dimeo, 61, of Budd Lake, N.J., and Fort Myers, Fla., pleaded guilty to two separate accusations before Superior Court Judge Michael A. Toto in Middlesex County. Dimeo retired last year, but he formerly operated Passaic Chiropractic & Therapy Center PC in Passaic. In pleading guilty, Dimeo admitted that between 2009 and 2015, he received approximately $254,500 in illegal kickbacks for patient referrals. NJ

April 29, 2016

Hollister Inc., a manufacturer of disposable health care products, and Byram Healthcare Centers Inc., a supplier of medical products, agreed to respectively pay roughly $11.4 million and $9.4 million to resolve allegations they violated the False Claims Act through an illegal kickback scheme.  According to the government, Hollister paid kickbacks to Byram in return for marketing promotions, conversion campaigns and other referrals of patients to Hollister’s ostomy and continence care products.  The government claimed that Byram also received kickbacks from three other manufacturers of ostomy and continence care products, namely Coloplast Corp., Montreal Ostomy and Safe N’ Simple.  The allegations originated in a whistleblower lawsuit filed by two former employees and one current employee of Coloplast under the qui tam provisions of the False Claims Act.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ

April 18, 2016

Miami physician Henry Lora was sentenced to 108 months in prison for his role in a Medicare fraud scheme that caused approximately $30 million in losses.  Lora was the medical director of Miami-area clinic Merfi Corporation and admitted that in exchange for kickbacks and bribes, he and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided.  He also admitted falsifying patient records to make it appear as if the beneficiaries qualified for these services.  In March 2014, Merfi owner was sentenced to nine years in prison for conspiracy to commit health care fraud.  DOJ