Anti-Kickback and Stark

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

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