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Anti-Kickback and Stark

This archive displays posts tagged as relevant to the Anti-Kickback Statute and Stark Law.

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Page 51 of 60

October 16, 2015

South Carolina-based Tuomey Healthcare System agreed to pay $72.4 million to settle charges of violating the False Claims Act by billing Medicare for services referred by physicians with whom the hospital had improper financial relationships.  Under the settlement, Tuomey also will be sold to Palmetto Health, a multi-hospital healthcare system based in Columbia, South Carolina.  According to the government, Tuomey violated the Stark law by entering into contracts with 19 specialist physicians that required them to refer their outpatient procedures to Tuomey in exchange for compensation that far exceeded fair market value and included part of the money Tuomey received from Medicare for the referred procedures.  The settlement follows a jury trial where the court entered judgement against Tuomey for more than $237 million.  The case arose from a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Michael K. Drakeford, an orthopedic surgeon who was offered, but refused to sign, one of the illegal contracts.  Dr. Drakeford will receive a whistleblower award of roughly $18.1 million from the settlement.  Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

October 16, 2015

A federal jury in Los Angeles convicted Amalya Cherniavsky and her husband, Vladislav Tcherniavsky, for conspiracy to commit health care fraud in connection with a $1.5 million Medicare fraud scheme.  The evidence at trial demonstrated that Cherniavsky owned JC Medical Supply, a purported durable medical equipment supply company, and that she co-operated the company with her husband, Tcherniavsky, and that they paid illegal kickbacks to patient recruiters in exchange for patient referrals.  The evidence further showed that the defendants paid kickbacks to physicians for fraudulent prescriptions – primarily for expensive, medically unnecessary power wheelchairs – which the defendants then used to support fraudulent bills to Medicare.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,

October 15, 2015

Shreveport, Louisiana community mental health center Westwood Mental Health LLC, and its parent company MedSouth LLC, agreed to pay $3.5 million to settle False Claims Act and Anti-Kickback Statute allegations that Westwood falsified patient records, billed for services not medically necessary, billed for services that were not rendered, provided bribes to Medicare beneficiaries who did not qualify for partial hospitalization services and provided bribes and/or kickbacks to employees to further or conceal the fraud.  DOJ (WDLA)

Tagged in: Anti-Kickback and Stark, FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

October 7, 2015

Kentucky-based nursing home pharmacy PharMerica Corp. agreed to pay $9.25 million to resolve allegations it violated the False Claims Act by soliciting and receiving kickbacks from pharmaceutical manufacturer Abbott Laboratories in exchange for promoting the anti-epileptic prescription drug Depakote for nursing home patients.  The settlement is part of the continuing fallout of the $1.5 billion settlement Abbott entered into with the government in May 2012 to resolve Abbott’s liability under the False Claims Act for alleged kickbacks to nursing home pharmacies, including PharMerica.  The settlement partially resolves allegations raised in two whistleblower lawsuits brought by former Abbott employees Richard Spetter and Meredith McCoyd under the qui tam provisions of the False Claims Act.  Ms. McCoyd will receive a whistleblower award of $1 million from the federal share of the settlement amount. Whistleblower Insider

Tagged in: Anti-Kickback and Stark, FCA Federal, Multiple Whistleblowers and First-to-File, Off-Label and Unapproved Use, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,

October 1, 2015

Nurses’ Registry and Home Health Corporation and the Estate of its former owner, the deceased Lennie House, agreed to pay $16 million to resolve allegations that Nurses’ Registry, at the direction of Lennie House, violated the False Claims Act by fraudulently billing Medicare for medically unnecessary home health services and for services tainted by kickbacks provided by the company and House to local physicians and others who referred patients to Nurses’ Registry.  According to the government, Nurses’ Registry falsified medical records to make it appear as if patients had a medical need for skilled nursing or therapy services, or appear as if the patients were homebound.  In addition to billing Medicare for unnecessary or non-reimbursable home health services, Nurses’ Registry and House provided tickets to athletic events and concerts, and provided other things of value, to doctors and referral sources in order to induce or reward patient referrals.  The allegations originated in a whistleblower lawsuit filed by former employees Alisia Robinson-Hill and David Price under thequi tam provisions of the False Claims Act.  They will receive a yet-to-be-determined whistleblower award from the settlement proceeds.  DOJ (KY)

Tagged in: Anti-Kickback and Stark, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

October 1, 2015

Strata Pathology Laboratory, Inc. (known as StrataDx) agreed to pay $558,793 to resolve allegations it violated the False Claims Act by inducing physicians to refer Medicare and Medicaid patients to Strata by paying kickbacks in the form of sham consulting fees and providing unlawful discounts to physicians.  According to the settlement agreement, Strata acknowledged paying consulting fees to two referring physician practices that did not provide consulting services in exchange.  Strata also acknowledged entering into “account billing” arrangements with seven referring physician practices that facilitated fee-splitting between the parties.  The allegations originated in a whistleblower lawsuit filed by a former Strata employee under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from a portion of the government’s recovery.  DOJ (MA)

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

September 21, 2015

Non-profit healthcare organization Adventist Health System agreed to pay $115 million to settle allegations it violated the False Claims Act by maintaining improper compensation arrangements with referring physicians and by miscoding claims.  The allegations originated in two whistleblower lawsuits filed by former Adventist hospital employees Michael Payne, Melissa Church and Gloria Pryor under the qui tam provisions of the False Claims Act.  The will receive a yet-to-be-determined whistleblower award from the government’s recovery. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Medical Billing Fraud, Multiple Whistleblowers and First-to-File, Whistleblower Case, Whistleblower Rewards,

September 15, 2015

North Broward Hospital District, operator of hospitals and other health care facilities in the Broward County, Florida area, agreed to pay $69.5 million to settle allegations it violated the False Claims Act by engaging in improper financial relationships with referring physicians.  According to the government, the hospital district provided compensation to nine employed physicians that exceeded the fair market value of their services violating both the Stark Statute and False Claims Act.  The allegations first arose from a whistleblower lawsuit filed by Dr. Michael Reilly under the qui tam provisions of the False Claims Act.  Dr. Reilly will receive a whistleblower award of roughly $12 million.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Whistleblower Case, Whistleblower Rewards,

September 4, 2015

Columbus Regional Healthcare System and Dr. Andrew Pippas agreed to pay more than $25 million to resolve allegations they violated the False Claims Act by submitting claims in violation of the Stark Law.  The settlement also resolves allegations that Columbus Regional and Pippas submitted claims for payment to federal health care programs that misrepresented the level of services they provided.  According to the government, between 2003 and 2013, Columbus Regional provided excessive salary and directorship payments to Pippas that violated the Stark Law.  The government further alleged Columbus Regional submitted claims to federal health care programs for services at higher levels than supported by the documentation.  The allegations first arose in two whistleblower lawsuits filed former Columbus Regional executive Richard Barker under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act.  Barker will receive a yet-to-be-determined whistleblower award.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Hospital Fraud, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

August 25, 2015

A federal jury in Miami convicted Roger Rousseau, former medical director of Health Care Solutions Network Inc. (HCSN), and three HCSN therapists for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.  HCSN is a now-defunct partial hospitalization program that purported to provide intensive treatment for mental illness.  According to the evidence presented at trial, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided and paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.  DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

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