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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:

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December 7, 2022

Dignity Health and the Tenet Healthcare hospitals Twin Cities Community Hospital and Sierra Vista Regional Medical Center will pay a total of $22.5 million to resolve allegations that they submitted false claims to Medi-Cal in connection with the ACA’s Medicaid Adult Expansion program.  The defendants, who contracted with Medi-Cal, agreed to provide healthcare services to this newly-insured population and return surplus funds if they did not spend at least 85% of the specified funds on eligible services.  The government alleged that the hospitals falsely billed for “Enhanced Services,” which allowed them to overstate AE spending, including by billing for services that were duplicative of services already required. The settlements resolve claims brought in a whistleblower action by Julio Bordas, who previously served as a Medical Director for CenCal Health, the County Organized Health System through which Medi-Cal contracted with the hospitals. Bordas will receive $3.9 million as his share of the federal recovery.  DOJ; USAO CD Cal; CA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

December 6, 2022

Centene will pay $17 million to the State of Oregon to resolve an investigation that the company, which served as a pharmacy benefit manager for the state’s Medicaid program, failed to provide certain pharmacy discounts in Oregon, resulting in inflated fees paid to Centene.  OR

Tagged in: Drug and DME Pricing, FCA State, Healthcare Fraud, Medicaid, Pharma Fraud,

October 3, 2022

South Carolina-based Radeas, LLC has agreed to pay $3.6 million to settle allegations of submitting false claims to North Carolina’s Medicaid program.  Radeas had allegedly billed Medicaid for simultaneously-performed presumptive and definitive urine drug tests, in violation of Medicaid policy and standard practice to run definitive tests after presumptive tests come back positive.  NC AG

Tagged in: FCA State, Healthcare Fraud, Laboratory and IDTF, Medicaid,

Crypto projects are toying with public funds. The False Claims Act will be a powerful tool in holding them to account

Posted  09/21/22
cryptocurrency and stocks
Last month, the Fairfax County Retirement System shared that they will be putting $70 million of their $6.8 billion fund into two crypto yield farming funds. In other words, pension money that allows teachers, firefighters, and police officers to retire will be invested into volatile digital tokens known as yield-farming projects. Yield-farming projects offer yields that are significantly higher than those...

Tagged in: Cryptocurrency, FCA State, Financial and Investment Fraud,

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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)

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

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

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

July 27, 2022

ca Glenn Pair and Markuetric Stringfellow will spend 70 and 78 months in prison, respectively, and pay over $5 million each in restitution for defrauding three States’ Medicaid programs of more than $5 million, and for receiving $1.8 million in kickbacks from participating laboratories. The two owned and operated Do-It-4-The Hood Corporation in North Carolina and later expanded to Georgia. They targeted Medicare-eligible children, enrolled them in their programs, and required them to submit urine specimens for drug testing. Drug testing was in turn billed to Medicaid by complicit laboratories, who then paid kickbacks after receiving Medicaid reimbursement. Through their Wrights Care Services LLC franchise in South Carolina, the two filed fraudulent Medicaid claims for mental health counseling, going so far as to host a “note party,” upon learning of a Medicare audit of Wrights Care, to cover up their scheme by creating false billing records to substantiate their fraudulent Medicaid claims. USAO WDNC, USAO SC

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud,

July 26, 2022

Dr. Don Flanagan, D.D.S. and his companies Dental Center, Inc. and Dental Center, P.C. d/b/a Cloudland Dental, will pay $1.5 million for submitting or causing to be submitted claims for payment by falsely identifying Dr. Flanagan as the credentialed physician rendering services. TennCare requires dentists to be credentialed as part of the approval process for billing, yet, from January 2015 through February 2019, services were rendered by uncredentialed dentists, which is a violation of the Tennessee Medicaid False Claims Act. EDTN USAO

Tagged in: FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud,

July 26, 2022

Mallinckrodt ARD, LLC f/k/a Questcor Pharmaceuticals, Inc. will pay over $233 million over a 7-year period to settle False Claims Act violations, which occurred from January 2013 through June 2020. During this time, Mallinckrodt knowingly underpaid Medicaid rebates on its H.P. Acthar Gel. The practice was exposed by a whistleblower lawsuit originally filed in Massachusetts. Mallinckrodt paid rebates for Achtar in 2013 as if it was a “new drug” rather than one that was introduced to the market in 1952. NJ OAG

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

July 14, 2022

BioReference Health, LLC, formerly known as BioReference Laboratories, Inc. and OPKO Health, Inc., have agreed to pay nearly $10 million and enter into a five-year Corporate Integrity Agreement to settle a whistleblower-brought case alleging it violated the Anti-Kickback Statute, Stark Law, and False Claims Act.  The alleged misconduct involved making lease payments to healthcare providers that exceeded fair market value, and later failing to report or return any overpayments to federal healthcare programs.  USAO MA

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

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