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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 60

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare.  Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic.  Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided.  DOJ

August 13, 2015

Two Southwest Missouri health care providers agreed to pay $5.5 million to settle allegations they violated the False Claims Act by engaging in improper financial relationships with referring physicians.  The two providers are Mercy Health Springfield Communities (formerly known as St. John’s Health System Inc.) and its affiliate, Mercy Clinic Springfield Communities (formerly known as St. John’s Clinic).  Specifically, the government charged the hospitals with submitting false claims to Medicare for services rendered to patients referred by physicians who received bonuses based on a formula that improperly took into account the value of the physicians’ referrals of patients to the clinic.  The allegations first arose in a whistleblower lawsuit filed by Dr. Jean Moore, a physician who is employed by one of the defendants, under the qui tam provisions of the False Claims Act.  Dr. Moore will receive a whistleblower award of $825,000.  DOJ

July 30, 2015

California-based medical device manufacturer NuVasive Inc. agreed to pay $13.5 million to resolve charges it violated the False Claims Act by improperly promoting the company’s CoRoent System for spine surgeries for uses not approved by the Food and Drug Administration.  The settlement also resolves allegations NuVasive paid illegal kickbacks to induce physicians to use the company’s CoRoent System.  The government’s allegations originated in a whistleblower lawsuit filed by former NuVasive sales representative Kevin Ryan under the qui tam provisions of the False Claims Act.  He will receive a whistleblower reward of approximately $2.2 million.  Whistleblower Insider

July 27, 2015

Zafar Mehmood and Badar Ahmadani, owners of two home health care agencies, were convicted of various offenses based on their roles in a $33 million Medicare fraud scheme.  According to evidence presented at trial, Mehmood and Ahmadani paid cash kickbacks to recruiters, who in turn paid cash to patients to induce them to sign up for home health care with Mehmood’s companies:  Access Care Home Care Inc., Patient Care Home Care Inc., Hands On Healing Home Care Inc. and All State Home Care Inc.  The evidence also showed that the defendants paid kickbacks to physicians to refer patients to the defendants’ companies for unnecessary home health care services.  DOJ

July 24, 2015

Mohammed Sadiq was sentenced to 80 months in prison and to pay $14.1 million in restitution for his leading role in a $12.6 million Medicare and tax fraud scheme.  Sadiq, who owned and directed operations at two home health care companies in Detroit, admitted billing Medicare for home health services not medically necessary or provided and paying kickbacks to patient recruiters to obtain Medicare beneficiary information used in his scheme.  DOJ

July 8, 2015

New Jersey doctor Frank Santangelo was sentenced to 63 months in prison and to forfeit more than $1.8 million for accepting $1.8 million in bribes to refer millions of dollars in business to Biodiagnostic Laboratory Services LLC.  Including Santangelo, 38 people, 26 of them doctors, have pleaded guilty in connection with the bribery scheme, which its organizers have admitted involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and various private insurance companies.  DOJ

June 16, 2015

Hebrew Homes Health Network Inc., a Florida-based operator of rehabilitation and skilled nursing facilities, along with its former president and executive director William Zubkoff, agreed to pay $17 million to resolve allegations it violated the False Claims Act by improperly paying doctors for referrals of Medicare patients requiring skilled nursing care.  It is the largest settlement involving alleged violations of the Anti-Kickback Statute by skilled nursing facilities in the US.  The allegations against Hebrew Homes first arose in a whistleblower lawsuit filed by Stephen Beaujon, a former CFO of Hebrew Homes, under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $4.25 million.  Whistleblower Insider

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme.  Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit.  Clearview is now owned by Community Health Systems which purchased HMA in January 2014.  According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute.  As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act.  The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $119,031.  DOJ, GA

May 20, 2015

Pharmacy benefits manager Medco Health Solutions Inc., a wholly-owned subsidiary of the pharmacy benefit manager Express Scripts Holding Company, agreed to pay $7.9 million to settle allegations it engaged in a kickback scheme in violation of the False Claims Act.  According to the government, Medco solicited remuneration from AstraZeneca in exchange for identifying Nexium as the “sole and exclusive” proton pump inhibitor on certain of Medco’s prescription drug lists known as formularies.  AstraZeneca allegedly compensated Medco in the form of reduced prices on the following AstraZeneca drugs: Prilosec, Toprol XL and Plendil.  In January 2015, the government reached a $7.9 million settlement with AstraZeneca to resolve kickback allegations arising out of the same conduct.  The allegations first arose in a whistleblower lawsuit filed by former AstraZeneca employees Paul DiMattia and F. Folger Tuggle under the qui tam provisions of the False Claims Act.  They will receive a whistleblower reward from the recovery that has yet to be determined.  DOJ

May 14, 2015

Westchester County Health Care Corporation (d/b/a Westchester Medical Center) agreed to pay $18.8 million to settle charges it violated the False Claims Act, the Anti-Kickback Statute and the Stark Law.  According to the government, from approximately 2000 through 2007, WMC maintained a financial relationship with Cardiology Consultants of Westchester, P.C., a cardiology practice formerly operating on WMC’s Valhalla campus.  WMC allegedly advanced monies to CCW to open a practice for the express purpose of generating referrals to the hospital.  When CCW began making payments to WMC purportedly repaying the advances, WMC entered into retroactive, no-work consulting agreements under which it paid CCW tens of thousands of dollars.  WMC also allegedly allowed CCW to use WMC’s fellows in CCW’s private office free of charge, contrary to WMC’s historic practice.  DOJ
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