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

Page 5 of 172

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

Posted  08/24/22
By Hallie Noecker, Max Voldman
Doctor with stethoscope on computer screen
Prior to the pandemic, telehealth was basically nonexistent, with one study clocking the percentage of “virtual” doctors’ visits before Covid-19 at zero percent. At the time, America’s largest insurer, Medicare, only covered telemedicine in limited circumstances that usually still involved a visit to a healthcare facility. Medicare’s coverage limitations demonstrated the Department of Health and Human...

August 23, 2022

Texas-based Cockerell Dermatopathology (CDP) has agreed to pay $3.75 million to resolve allegations of allowing millions of dollars in fraudulent claims to be submitted to TRICARE, in violation of the False Claims Act.  According to a government suit, CDP’s principal physician, Dr. Clay Cockerell, had allowed laboratory management company Progen to use its license to submit false claims for medically unnecessary tests in exchange for a twenty percent cut of the proceeds.  USAO NDTX

August 23, 2022

Essilor International and related subsidiaries, which manufacture, market, and distribute optical lenses and equipment to produce optical lenses—have agreed to pay $22 million to resolve federal and state allegations of defrauding Medicare and Medicaid.  In two separate qui tam suits, former sales managers Laura Thompson and Lisa Brez, and Christie Rudolph alleged that Essilor violated the Anti-Kickback Statute and False Claims Act by paying illegal kickbacks to optometrists and opthalmologists to induce purchases of their products for patients, including patients covered by Medicare and Medicaid.  $5.6 million of the total settlement was allocated between states that were parties to the settlements, and $16.4 million to the federal government. DOJ; USAO EDPA; USAO NDTX; CO; CT; SD (see later CA settlement)

August 18, 2022

The organized healthcare system for Ventura County, as well as three healthcare providers, have agreed to pay a combined total of $70.7 million to resolve allegations of violating the California and federal False Claims Acts in connection with Medi-Cal’s Adult Expansion program, which extended coverage to previously uninsured adults without dependents.  Gold Coast Health Plan, Dignity Health, Clinicas del Camino Real, Inc., and Ventura County (the owner and operator of Ventura County Medical Center) allegedly submitted, or caused to be submitted, bills for unallowed expenses, bills for “Additional Services” that were duplicative of services already required, and bills with pre-determined costs that weren’t reflective of fair market value.  CA AG; USAO CDCA

August 15, 2022

Flight instruction company Universal Helicopters Inc. will pay $7 million, and Dodge City Community College will pay $500,000, to resolve claims that the defendants made false statements to the VA in order to receive funding through the Post-9/11 GI Bill program for training programs they jointly ran.  Specifically, the defendants were alleged to have falsely certified that no more than 85 percent of the students in helicopter flight instructor programs were receiving VA benefits.  The government’s investigation was initiated by a whistleblower suit brought under the False Claims Act by a veteran and former student in the program, William Rowe.  Rowe will receive $1.125 million of the settlement.  DOJ

August 11, 2022

Menswear company Luchiano Visconti Loutie LLC d/b/a Luchiano Visconti and its manager Sasha Hourizadeh will pay $3.64 million for violating the False Claims Act by underreporting the value of imported apparel, resulting in over $1.8 million in evaded customs duties. Visconti and Hourizadeh regularly provided falsified invoices to customs brokers that significantly understated the true value of the imported menswear. In some instances, a complicit foreign manufacturer would provide Visconti two sets of invoices—one reflecting itemized pricing details at a reduction, and the second reflecting “services” provided which, when combined, reflected the actual value of the goods. A related whistleblower suit was filed prior to the Government joining the matter. USAO SDNY

August 11, 2022

Spivack, Inc., formerly operating as Verree Pharmacy, and owner-pharmacist Mitchell Spivack, have agreed to pay over $4.1 million in civil penalties for dispensing opioids despite numerous red flags the drugs were being diverted—all in violation of the False Claims Act and the Controlled Substances Act. In furtherance of the fraud, Spivack made false statements to drug distributors to maintain the façade of legitimacy, while concurrently drawing millions from the pharmacy and harming the public. In addition to their opioid fraud, Spivack and Verree effectuated their “Bill But Don’t Fill” scheme, where they would enter “BBDF” in their internal computer system, and would submit false claims to insurers for drugs not actually dispensed. USAO EDPA

August 11, 2022

Industrial battery maker Eos Energy Storage LLC will pay $1.02 million, after a whistleblower filed suit alleging violations of the False Claims Act. From mid-2018 to mid-2019, Eos failed to declare the value of certain components shipped overseas to be assembled and then imported back into the United States. Eos also failed to declare transportation and packing costs on more than 60 occasions, which Eos further acknowledged was their responsibility as importer of record. The whistleblower will receive 20% of the settlement amount. USAO NJ

August 10, 2022

American Senior Communities, L.L.C., will pay over $5.5 million for violating the False Claims Act by charging Medicare directly for hospice services that should have already been covered by the beneficiaries’ Medicare hospice coverage. The fraudulent billing practice was exposed in a whistleblower complaint filed by a former employee of a hospice services provider that worked with ASC. The whistleblower is entitled to receive between 15 and 25% of the recovery. USAO SDIN

August 5, 2022

Gonzaga Interventional Pain Management, Melvin Gonzaga, M.D., and his son Rommel Gonzaga will pay $980,000 for violating the False Claims Act by submitting claims for medically unnecessary urine drug tests. GIPM required patients to submit a UDT sample before being seen by a provider and discussing the results from any prior UDT the patient received. Regardless of the patients’ individualized testing needs, GIPM always opted for the more complex “definitive” UDT rather than the lower-level “presumptive” UDT, netting a higher reimbursement rate from the US government. USAO MD
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