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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 52 of 61

October 29, 2015

Warner Chilcott US Sales LLC, a subsidiary of pharmaceutical manufacturer Warner Chilcott PLC, agreed to plead guilty to a felony charge of health care fraud as part of a global settlement in which Warner Chilcott agreed to pay $125 million to resolve its criminal and civil liability arising from illegally marketing the drugs Actonel, Asacol, Atelvia, Doryx, Enablex, Estrace and Loestrin in violation of the False Claims Act and Anti-Kickback Statute.  Specifically, the government charged that between 2009 and 2013, Warner Chilcott paid physicians to induce them to prescribe Warner Chilcott drugs.  The government also alleged that Warner Chilcott employees submitted false or misleading prior authorization requests and other coverage requests to federal health care programs for the osteoporosis medications Atelvia and Actonel.  The government further claimed that Warner Chilcott employees were instructed by members of the company’s management team to make unsubstantiated superiority claims when marketing the drug Actonel.  The allegations first arose in a whistleblower lawsuit by two former Warner Chilcott sales representatives filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive a whistleblower award of approximately $22.9 million from the federal share of the civil recovery.  Whistleblower Insider

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

October 26, 2015

Valentina Kovalienko, the owner of two Brooklyn medical clinics, pleaded guilty to, and agreed to forfeit almost $30 million for, her role in a $55 million health care fraud and money laundering conspiracy.  According to her admissions, from approximately February 2008 to February 2011, Kovalienko and others executed a scheme in which patients were paid cash kickbacks to subject themselves to medically unnecessary physical and occupational therapy, diagnostic tests and office visits that were not performed by licensed professionals, and for which the clinics billed Medicare and Medicaid.  Kovalienko also admitted that to support the fraudulent claims she paid occupational and physical therapists to falsify patient charts and billing records.  DOJ

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

October 19, 2015

Millennium Health (formerly Millennium Laboratories) agreed to pay $256 million to the federal and state governments to resolve charges it billed Medicare for medically unnecessary urine drug and genetic testing.  According to the government, Millennium caused physicians to order excessive numbers of urine drug tests, in part through the promotion of “custom profiles,” which instead of being tailored to individual patients were in effect standing orders that caused physicians to order large number of tests without an individualized assessment of each patient’s needs.  The government further alleged that Millennium’s provision of free point of care urine drug test cups to physicians — expressly conditioned on the physicians’ agreement to return the urine specimens to Millennium for hundreds of dollars’ worth of additional testing — violated the Stark Law and the Anti-Kickback Statute.  The case originated from several whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Whistleblowers in the underlying cases will receive awards totalling roughly $32 million.  DOJ GA , FL, WA

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

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,

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