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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 55 of 62

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

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

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

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

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

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

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

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

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

Tagged in: Anti-Kickback and Stark, FCA Federal, Hospital Fraud, Provider Fraud,

May 1, 2015

Accredo Health Group, a unit of Express Scripts Holding Co., agreed to pay $60 million to settle False Claims Act and Anti-Kickback Statute charges that the company participated in a kickback scheme with Novartis Pharmaceuticals Corp. involving the prescription drug Exjade.  According to the government, Novartis provided kickbacks, in the form of patient referrals and related benefits, to Accredo in exchange for Accredo recommending refills to Exjade patients.  The government also intervened in a whistleblower lawsuit against Novartis for the same alleged scheme.  The government claims defendants allegedly understated the serious and potentially life-threatening side effects of Exjade when promoting the drug’s benefits to patients. FBI

Tagged in: Anti-Kickback and Stark, FCA Federal, Pharma Fraud,

April 29, 2015

The Hospital Authority of Irwin County (ICH) and several doctors agreed to pay $520,000 to settle charges they violated the False Claims Act, the Anti-Kickback Statute, the Stark Law and related Georgia Medicaid policies in connection with the amount of compensation paid by ICH to one of the doctors, ICH’s leases with the doctors, and the supervision of certain diagnostic imaging services at ICH.  The allegations first arose in a whistleblower lawsuit filed by Connie Brogdon and Summer Holland under the qui tam provisions of the False Claims Act and the Georgia False Medicaid Claims Act.  They will receive an undisclosed portion of the settlement payment.  DOJ

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

April 21, 2015

Family Dermatology P.C., which owns and operates a dermatopathology lab in Georgia and several dermatology practices throughout the Eastern United States, agreed to pay $3,247,835 to settle allegations it violated the False Claims Act and the Stark Statute by engaging in improper financial relationships with a number of its employed physicians.  According to the government, Family Dermatology routinely required its dermatologists to use Family Dermatology’s in-house pathology lab, which operated under the name Nelson Dermatopathology, for their pathology services.  The allegations first arose in three whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Scott M. Ross MD, Mark F. Baucom and Harold Milstein MD.  They will collectively receive a whistleblower award of more than $584,000.  DOJ

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

April 21, 2015

Texas-based Citizens Medical Center agreed to pay $21,750,000 to settle allegations it violated the False Claims Act and Stark Statute by engaging in improper financial relationships with referring physicians.  According to the government, the hospital provided compensation to several cardiologists that exceeded the fair market value of their services and paid bonuses to emergency room physicians that improperly took into account the value of their cardiology referrals.  The allegations first arose in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dakshesh “Kumar” Parikh, Harish Chandna and Ajay Gaalla.  They will collectively receive a whistleblower award of $5,981,250.  DOJ

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

April 16, 2015

Felix Gonzalez, owner of Miami home health care company AA Advanced Care Inc. was ordered to pay $21,423,160 in restitution and sentenced to 113 months in prison in connection with a $32 million Medicare fraud scheme.  Gonzalez admitted operating his company for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were not medically necessary or provided at all.  He further admitted he negotiated and paid kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.  DOJ

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

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