When a Gift is Not a Gift: Pharma Companies Use Charities to Increase Drug Profits
Posted 12/13/18
FCA Federal
This archive displays posts tagged as relevant to the federal False Claims Act. You may also be interested in the following pages:
December 13, 2018
Hospice care provider SouthernCare, Inc. has agreed to pay $5,863,426 for submitting fraudulent claims to Medicare between 2009 to 2014. Under Medicare's eligibility rules, in order for hospice care to be reimbursed, a patient must have a life expectancy of six months or less as certified by a physician, and terminal illnesses must be documented with appropriate records. However, according to qui tam complaints by former employees Dawn Hamrock and Patricia Beegle, SouthernCare billed Medicare for care provided to patients who were not Medicare eligible or who had no proof of Medicare eligibility. As part of the settlement, Hamrock and Beegle will share a $1.1 million whistleblower reward. USAO EDPADecember 12, 2018
Finance of America Mortgage LLC has agreed to pay $14.5 million to the United States to resolve its liability under the False Claims Act in connection with deficient mortgage loans originated by a company it acquired. The acquired company, Gateway Funding Diversified Mortgage Services, L.P. (Gateway), had participated in the Federal Housing Administration's insurance program as a direct endorsement lender (DEL), which gave it the authority to originate, underwrite, and endorse mortgages with minimal oversight from the FHA. However, as reported by a former Gateway employee in a qui tam complaint, the company failed to comply with the stricter procedures required of DELs, including failing to conduct audits on early-payment default loans, repeatedly failing to correct high rates of default, and failing to self-report deficient loans to the FHA. For exposing the fraud, the unnamed relator will receive a share of $2,392,500. USAO NDNYDecember 11, 2018
A New York-based audiology practice has agreed to pay $566,263.08 in connection with alleged violations of the False Claims Act and Anti-Kickback Statute. According to an unnamed whistleblower, Oviatt Hearing and Balance, LLC improperly billed Medicare and TRICARE for services rendered by unlicensed and unsupervised employees, as well as provided inappropriate inducements in the form of free iPads, Butterball turkeys, and gift cards, to Medicare and TRICARE beneficiaries to get them to choose Oviatt over other providers. For their role in exposing the fraud, the whistleblower stands to receive a relator's share of $120,000. USAO NDNYDecember 11, 2018
Following qui tam complaints filed by two former employees, Western Medical Group and owners Benjamin George and Jody Rookstool have agreed to pay a total of $1,634,844 to settle allegations that the company violated the False Claims Act in submissions to Medicare. The two complaints, filed in December 2013 and February 2014, alleged that Western Medical violated Medicare's reimbursement rules by using a telemarketing company to solicit sales of knee and back braces from eligible Medicare beneficiaries. USAO UTDecember 11, 2018
Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act in claims submitted to Medicare, Medicaid, and federal employee health insurers. From 2007 until 2014, under DiIorio's direction, Coordinated Health allegedly exploited a billing code called Modifier 59 in order to separately bill for orthopedic surgery charges that, properly billed, instead fall under a single "global" payment for each surgery. Even after outside consultants warned company executives about the improper practice in 2011 and 2013 and provided on-site training on the proper use of Modifier 59, Coordinated Health continued making false claims, causing federal healthcare payers to overpay by millions of dollars. As part of the settlement, the company has signed a Corporate Integrity Agreement for additional government oversight into its billing practices over the next five years. USAO EDPADecember 11, 2018
Aurora Health Care, Inc. has agreed to pay $12 million to settle allegations of defrauding Medicare and Wisconsin's Medicaid program in certain reimbursement claims filed between 2008 to 2012. According to the United States and State of Wisconsin, the healthcare provider and two physicians entered into improper financial relationships in violation of the federal and state False Claims Acts as well as the Stark Law. As a result, some of the claims that Aurora submitted to the government health programs were improper. Despite alerting the government to the illegal arrangement, a qui tam complaint filed by unnamed whistleblowers alleged different claims. Although the whistleblowers will still receive a share of the recovery, the government did not intervene in their lawsuit, which will be dismissed as part of the settlement. USAO EDWIDOJ Affirms its Materiality Provision but Threatens to Dismiss Gilead FCA Case
Posted 12/7/18
