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FCA Federal

This archive displays posts tagged as relevant to the federal False Claims Act. You may also be interested in the following pages:

Page 12 of 182

January 20, 2023

DePuy Synthes, Inc., a subsidiary of Johnson & Johnson that manufactures medical devices, has agreed to pay $9.75 million to resolve allegations of defrauding Medicare and Medicaid.  According to former sales representative Aleksej Gusakovs, DePuy gave a Massachusetts-based orthopedic surgeon thousands of dollars’ worth of free implants and instruments for use in overseas surgeries.  The illegal kickbacks induced the surgeon to use DePuy products in surgeries performed in the United States, and caused false claims to be submitted to Medicare and the Massachusetts Medicaid program.  As the whistleblower in a successful qui tam action, Gusakovs will receive a $1.37 million share of the settlement.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

January 12, 2023

Blue Water Shipping U.S. Inc. has agreed to pay $1.89 million to settle claims that one of its former employees billed the government for freight forwarding services that were never performed and charged the government unallowable markups for inland transportation, and imports and exports of ocean and air freight.  USAO NJ

Tagged in: FCA Federal, Government Procurement Fraud,

January 9, 2023

Doctor Aarti Pandya and her practice, Aarti D. Pandya, M.D. P.C., have agreed to pay $1.8 million to resolve a whistleblower suit that alleged they billed federal healthcare programs for medically unnecessary cataract surgeries and diagnostic tests, incomplete or worthless tests, and office visits that failed to provide the level of service claimed.  The allegations were brought in a 2013 qui tam suit by former employee Laura Dildine, which the government intervened on in 2018. In addition to the false claims listed above, Pandya also allegedly falsely diagnosed patients with glaucoma in order to justify claims for reimbursement.  USAO SDGA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

Top Ten Healthcare Fraud Recoveries of 2022

Posted  01/6/23
Healthcare fraud image showing stethoscope with gavel
Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare.  As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

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December 21, 2022

Biotechnology companies iSense, LLC and Specific Diagnostics, Inc., together with their founder Paul Andrew Rhodes, will pay a total of $10.1 million to resolve allegations that they submitted false claims under grants from the DOD and HHS.  The government alleged that the firms improperly billed for costs incurred by another business, billed for compensation in excess of authorized federal limits, backdated services and cost-sharing agreements, and knowingly presented a backdated agreement to the government. USAO NDCal

Tagged in: Defense Contract Fraud, Falsifying Invoices, FCA Federal, Grant and Research Fraud, Healthcare Fraud,

December 20, 2022

Cochlear implant manufacturer Advanced Bionics LLC paid $11.4 million to resolve claims brought in a whistleblower action that the company falsely stated that the radio-frequency (RF) emissions generated by some of its cochlear implant processors met international standards when it submitted pre-market approval applications to the FDA.  The company allegedly knew that the devices did not meet standards, and manipulated testing conditions to obtain passing test results.  Whistleblower David Nyberg, a former engineer at Advanced Bionics, will receive a qui tam award of $1.9 million from the federal amount of the settlement.  DOJ; USAO ED PA

Tagged in: FCA Federal, FDA Fraud, Healthcare Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

December 20, 2022

BioTelemetry Inc. and its subsidiary CardioNet LLC, which provide cardiac monitoring services (including Holter and mobile cardiovascular telemetry (MCT) tests), will pay $44.875 million to resolve claims that they submitted false claims to federal healthcare programs for cardiac monitoring services that were improperly performed overseas and by unqualified technicians.  CardioNet used an India-based contractor to perform diagnostic and analysis services of heart monitoring data, and while it had a formal policy of sending such data for federal healthcare beneficiaries to a U.S.-based independent diagnostic testing facility for review and analysis, in fact, substantial amounts of such data was sent to its Indian contractor.  The government further alleged that most of the offshore technicians tasked with reviewing ECG Data for federal healthcare program beneficiaries did not have the basic qualifications to perform the tests in question. The government’s investigation was initiated by a qui tam action filed by former CardioNet employees Christopher Strasinski and Philip Leone, who will share a whistleblower award of approximately $8.3 million.  DOJ; USAO ED PA

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

December 16, 2022

Youth rehabilitation center Pathway, Inc. and Pathway of Baldwin County, LLC, have agreed to pay nearly $3.5 million to settle claims of billing the Alabama Medicaid program for services that were not actually provided.  The claims that Pathway was billing for basic living skills services that were not actually provided were raised by whistleblower Richard Sheppard in a 2017 lawsuit.  USAO SDAL

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Whistleblower Case,

December 15, 2022

A physician and his Connecticut-based urgent care practices have agreed to pay over $4.2 million to settle allegations of submitting false claims to Medicare and the Connecticut Medicaid program.  Jasdeep Sidana—the owner and CEO of Docs Medical Group, Inc., Docs Medical Inc., Docs Urgent Care LLP, Lung Docs of CT, P.C., Epic Family Physicians, LLP, and Continuum Medical Group, LLC (collectively, DOCS)—allegedly billed for immunotherapy services, including allergy testing and treatment, that were not medically necessary and not directly supervised by a physician.  Additionally, the defendants allegedly billed for COVID test administration using codes for more complex evaluation and management (“E&M”) services.  USAO CT

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Upcoding,

December 15, 2022

Florida-based Ocenture LLC and its subsidiary, Carelumina LLC, have agreed to pay $3 million to settle allegations of submitting claims to Medicare that were tainted by illegal kickbacks.  Two marketers approached by Ocenture to participate in the kickback scheme, Christopher Improta and Peter Brandt, filed a qui tam suit against Ocenture which alleged the company provided kickbacks to physicians to have them falsely attest that genetic tests Ocenture solicited directly from Medicare beneficiaries was medically necessary.  The whistleblowers also alleged that Ocenture arranged for laboratories to process those tests and pay it a portion of the laboratories’ Medicare reimbursements.  For instigating a successful enforcement action, Improta and Brandt will share a $570,000 award.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Whistleblower Case, Whistleblower Rewards,

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