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FCA State

This archive displays posts tagged as relevant to state and local False Claims Acts. You may also be interested in the following pages:

Page 22 of 33

August 1, 2018

Early Autism Project, Inc. (“EAP”) agreed to pay the United States $8,833,615 to settle allegations brought by whistleblower and former employee of EAP, Olivia Zeigler, that it submitted false claims to TRICARE (a military insurance program) and South Carolina’s Medicaid program for therapy services for children with autism. The therapy services were misrepresented or were never provided. EAP allegedly also created a program under which it billed Medicaid for functions that were not related to therapy services at all and permitted its therapists to regularly bill for more hours than they actually provided therapy services. Olivia Zeigler will be awarded $435,000. DOJ

Tagged in: FCA Federal, FCA State, Medicaid, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 31, 2018

Compassionate Home Care Services, Inc., its owner Carol Anders, and her son Ryan Santiago will pay a $3 million judgment for violating the federal and North Carolina False Claims Acts by filing reimbursement claims for services not rendered or rendered by unlicensed aides and family members. Anders and Santiago were also found to have falsified documents to conceal evidence of fraud upon being investigated by the government. USAO EDNC

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medical Billing Fraud,

Congratulations to Puerto Rico for Adopting a False Claims Act

Posted  07/27/18
On July 23, 2018, Puerto Rico Governor Ricardo Rosselló, signed into law anti-fraud legislation that includes provisions modeled after the federal False Claims Act. The Puerto Rico law, called the Fraudulent Claims to Programs, Contracts, and Services of the Government of Puerto Rico Act, has features critical to effective false claims acts:
  1. The Puerto Rico law permits whistleblowers to file qui tam lawsuits on...

Tagged in: FCA State, Legislation and Regulation News, Whistleblower Rewards,

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July 26, 2018

New York announced guilty pleas by transportation company 716 Transportation, Inc., its president, and one of its drivers, in connection with a $1.2 million Medicaid fraud scheme. The company and its president admitted to billing Medicaid for transportation services that were either never provided or that violated Medicaid rules and regulations. NY AG

Tagged in: Ambulance, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

July 9, 2018

NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) entered a $14.7 million settlement with DOJ and a $895,427 settlement with New York based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid.  Specifically, the defendants billed Medicare for undocumented E&M services, billed for home-health services without supporting medical records, and billed for orthopedic surgeons who referred patients in violation of the Physician Self-Referral Law, also known as the Stark Law.  Three former Health Quest employees, who filed suit under the qui tam provisions of the False Claims Act, will receive a share of the recovery, including a reward of nearly $2 million to one of the relators.  DOJ; USAO NDNY

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

July 3, 2018

A Virginia woman who owned several Medicaid support services companies has agreed to pay $1 million and to accept a lifetime ban on participation in the Virginia Medicaid Program as part of a settlement of allegations that she defrauded the program.  Dawn Sykes allegedly paid illegal kickbacks and sought reimbursement for services that were not provided or were provided to ineligible recipients.  The investigation was launched by a qui tam lawsuit under the FCA and Virginia Fraud Against Taxpayers Act, and the whistleblower will receive 18 percent of the settlement.  USAO EDVA

Tagged in: FCA Federal, FCA State, Medicaid, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

July 10, 2018

A Norwich behavioral health practice and its co-owners, a mother and her daughter who are both licensed behavioral health clinicians, agreed to a $300,000 settlement to resolve alleged violations of Connecticut’s False Claims Act. Affinity Behavioral Health LLC (“Affinity”) is co-owned by Julie Longton, a licensed marital and family therapist, and her daughter, Leanda Zupka, a licensed clinical social worker. Affinity, Longton and Zupka are enrolled as behavioral health providers in the Connecticut Medical Assistance Program (CMAP), which includes the state’s Medicaid program. The state alleged that, from April 2013 to December 2016, Affinity, Longton and Zupka knowingly submitted claims to the CMAP for payment for behavioral health services purportedly performed by licensed behavioral health clinicians when, in fact, the services were rendered by unlicensed individuals employed by Longton and Zupka. CT

Tagged in: FCA State, Improper Medical Personnel, Medicaid, Medical Billing Fraud,

July 5, 2018

North Carolina announced it has settled with Rotech Healthcare Inc., a Florida-based respiratory equipment supplier, over civil allegations that Rotech knowingly submitted false claims for portable oxygen contents to Medicaid and Medicare. The settlement is joined by 22 other states and the federal government. The total settlement is $9.95 million, of which North Carolina will receive $43,671.23. Between 2009 and 2012, Rotech automatically billed Medicaid and Medicare for portable oxygen contents regardless of whether the beneficiaries used or needed portable oxygen and without obtaining the required proof of delivery. Rotech continued this practice despite knowing that it was submitting ineligible claims. NC  The settlement is part of previously-reported settlement with the federal government and other states.  April 12 Federal Settlement. The case was initiated by a whistleblower.

Tagged in: FCA State, Medicaid, Medical Billing Fraud, Medical Devices and DME,

July 3, 2018

The state and federal governments reached a joint settlement resolving allegations that a Waterford psychologist submitted false claims for behavioral health services she never provided to her Connecticut Medicaid patients, Attorney General George Jepsen and Connecticut Department of Social Services (DSS) Commissioner Roderick L. Bremby. Dr. Arlene Werner, a licensed psychologist and owner and sole practitioner of a private psychology practice, will pay $126,760.09 and has been suspended from participation in the Connecticut Medical Assistance Program (CMAP) – which includes the state’s Medicaid program – for a period of two years. The state and federal governments alleged that, from January 2011 to July 2016, Dr. Werner submitted false claims to the CMAP for psychotherapy services that were not provided to her CMAP patients. CT

Tagged in: FCA Federal, FCA State, Medical Billing Fraud, Provider Fraud,

June 25, 2018

New York announced registered nurse Collins Anyanwu-Mueller has been sentenced to a year in prison for stealing over $390,000 from Medicaid. A MFCU investigation uncovered that Anyanwu-Mueller submitted false Medicaid claims for private duty nursing services that he never provided to two severely disabled Medicaid recipients. Both Medicaid recipients required around-the-clock care. Prior to sentencing, Anyanwu-Mueller paid the State of New York $25,000 and has agreed to pay the remaining $367,954 in restitution owed. NY

Tagged in: FCA State, Home Health and Hospice, Medicaid, Medical Billing Fraud,

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