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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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COVID Frauds of the Week: Fraud on Stimulus Programs and Consumers

Posted  07/31/20
handcuffs on a gavel with money scattered around
Like the virus itself, fraud that exploits the COVID-19 pandemic just will not go away, so we are back with another installment of our continuing series highlighting related government enforcement actions.  This week, we saw a continued enforcement focus in two areas: fraud on stimulus programs and consumers.

Stimulus Fraud

Three charges this week highlighted the government’s ongoing efforts to expose and bring...

Catch of the Week: Indivior Agrees to Pay $600 Million to Settle Opioid Fraud Case

Posted  07/31/20
pill container spilled over with pills in the form of a dollar sign
The latest in our Catch of the Week series features Indivior Solutions’ (“Indivior”) agreement to pay $600 million to resolve criminal and civil liability associated with the marketing of the opioid-addiction-treatment drug Suboxone. This is in addition to the $1.4 billion resolution with Indivior’s former parent, Reckitt Benckiser Group PLC (“RB Group”) that was previously announced in 2019. Suboxone is a...

OIG Audit Suggests Home Health Agencies Submit Unsupported Visits to Trigger Higher Medicare Reimbursement

Posted  07/31/20
visiting nurse with elder woman sitting on a couch
OIG released results from its targeted audit of certain home health care claims submitted for payment and found $191.8 million of overpayments in 2017 alone. OIG's objective was to determine whether payments for home health services with five to seven visits in a payment episode complied with Medicare requirements. During the 2017 audit period, under Medicare's home health prospective payment system, home health...

July 30, 2020

Computer Sciences Corporation (CSC), now known as DXC Technology, and New York City have agreed to pay approximately $2.8 million to resolve allegations of violating the federal and New York State False Claims Acts in connection with New York City’s Early Intervention Program (EIP), which provides speech and physical therapy services for infants and toddlers with possible developmental disabilities.  According to a qui tam lawsuit, while retained by the City to process and submit its EIP claims to various insurers, CSC allegedly received permission from the City to categorize claims submitted to private insurers as “denied” if no response was received within 90 days.  CSC then resubmitted those claims to Medicaid using an improper code, causing Medicaid to make payments it would not have otherwise.  For revealing the misconduct, the unnamed whistleblower in this case will receive $416,250.  AG NY; USAO SDNY

July 28, 2020

A pharmaceutical company accused of paying illegal inducements to physicians has agreed to pay $3.5 million to resolve allegations of violating the False Claims Act.  In order to induce physicians to prescribe its newly-launched local analgesic, EXPAREL, Pacira Pharmaceuticals Inc. allegedly paid doctors kickbacks that were half-heartedly disguised as grant money for research.  In order to receive the so-called research grant, Pacira required EXPAREL to be placed on formulary at the physician’s institution, but did not document why such research was needed or follow up on research results.  The fraud was eventually exposed by a pharmacist in a qui tam suit; the pharmacist will receive $638,000 as part of the settlement.  USAO NJ; AG FL

July 23, 2020

Two pharmacists who were co-owners of Advantage Pharmacy in Mississippi have been sentenced to over 12 years in prison each and ordered to pay between $9 million and $29 million in civil monetary judgment, and between $185 million and $189 million in restitution for committing healthcare fraud.  According to the press release, Glenn Doyle Beach and Hope Thomley marketed, dispensed, and distributed compounded medications without regard to medical necessity, causing various health benefit programs, including TRICARE, to pay over $200 million in reimbursements.  Thomley’s husband, Randy Thomley, has been sentenced to 8 years in prison and ordered to pay judgment and restitution of $3.6 million each for his role in helping to recruit TRICARE beneficiaries.  USAO SDMS

July 23, 2020

Progenity, Inc., f/k/a Ascendant MDx, Inc., has agreed to pay a total of $49 million to resolve allegations that the California-based clinical laboratory submitted false claims to Medicaid, the VA, TRICARE, and the Federal Employees Health Benefits Program (FEHBP) through different fraudulent schemes.  First, from 2012 to 2016, Progenity allegedly billed the programs for non-reimbursable prenatal tests using a reimbursable billing code.  Second, in claims originally brought by a whistleblower under the False Claims Act, the company was alleged to violate the Anti-Kickback Statue by providing improper incentives to physicians—including paying above fair market value for blood specimen “draw fees”, providing tens of thousands of dollars in free food and alcohol, and routinely reducing or waiving co-insurance or deductibles—in order to induce physicians to order their tests.  Approximately $35.9 million of the settlement proceeds will go toward resolving federal claims, with the remaining $13.1 million paid to different states.  AG NC; USAO SDCA; USAO SDNY

July 22, 2020

Tony Garrett Taylor has been sentenced to 8 years in prison and ordered to pay over $6 million to the North Carolina Medicaid program and over $1 million to the IRS after pleading guilty to committing healthcare fraud and tax evasion.  Along with his brother, Jerry Lewis Taylor, the defendant conspired to use outpatient behavioral health services companies owned and operated by the brothers to submit false claims to Medicaid for services that were either never provided or misrepresented.  Jerry Lewis Taylor has also pleaded guilty and is currently awaiting sentencing.  AG NC

July 21, 2020

The Montachusett Regional Transit Authority (MART), a quasi-public transportation authority that brokers medical transportation, will pay $300,000 to resolve allegations that it improperly caused false claims to be submitted to MassHealth, the Massachusetts state Medicaid program. MART allegedly did not have appropriate procedures in place to verify that its transportation subcontractors had actually provided rides as they claimed, and MART billed MassHealth for thousands of rides that were not, in fact, provided. MA; USAO MA

July 20, 2020

Drug testing laboratory Sterling Healthcare Opco, LLC, doing business as Cordant Health Solutions will pay $12 million to resolve allegations in a False Claims Act case brought by a whistleblower that it paid unlawful kickbacks to Northwest Physicians Laboratories, LLC and Genesis Marketing Group in exchange for referrals of urine drug tests paid for by federal healthcare programs and performed at Cordant labs in Tacoma (Regional Toxicology Services LLC d/b/a Sterling Reference Laboratory) and Denver (Rocky Mountain Tox LLC d/b/a Forensic Laboratories).  The whistleblower will receive 20% of the settlement, or approximately $2.4 millionUSAO WD WA
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