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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 1 of 86

DOJ Reports Decline in Total Fraud Recoveries in 2020, but Whistleblower Efforts and Rewards Continue

Posted  01/14/21
Department of Justice building entrance
In its annual report of recoveries in fraud and False Claims Act cases, the Department of Justice reported total recoveries of $2.2 billion for the fiscal year ending September 2020.  These recoveries represent the lowest reported DOJ recoveries since 2008. While it is the decline in recoveries that stands out, the 2020 DOJ fraud statistics do share some things in common with prior years.  First, whistleblowers...

Top Ten State Healthcare and Financial Fraud Recoveries of 2020

Posted  01/8/21
person raising the U.S. flag
State and local governments are on the front lines of enforcing anti-fraud laws and play a critical role in ensuring that businesses and individuals are held accountable.  Whistleblowers with information about corporate misconduct involving healthcare, government procurement, financial regulation, and tax may find that state proceedings offer them the best option. More than 30 states have False Claims Acts that...

COVID Fraud: New York Pharmacy Owners Indicted on Charges Arising from their Abuse of Emergency Override Billing Codes

Posted  01/7/21
Flashing lights on top of police car
As we have previously written, regulatory changes designed to alleviate logistical and financial pressure on healthcare providers during the COVID-19 crisis, while necessary, can create opportunities for fraudsters.  Last month, an indictment in New York revealed a scheme by two pharmacy owners who took advantage of relaxed rules regarding prescription prior authorization and refill timing to overcharge Medicare and...

January 6, 2020

Exceltox, a genetic testing laboratory in California, has agreed to pay $357,584 to resolve allegations of submitting false claims to Medicare over two months in 2015.  With the help of a New Jersey-based contractor named Seth Rehfuss, Exceltox allegedly performed genetic tests on seniors in New Jersey-based senior housing complexes without proper orders from a treating physician, then submitted claims to Medicare for these tests.  For his role in the fraud, Rehfuss was sentenced to over 4 years in prison in 2019.  USAO NJ

Top Ten Healthcare Fraud Recoveries of 2020

Posted  01/5/21
Healthcare Fraud
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

January 4, 2021

Three providers, James P. Anderson, as owner of Affiliated Neurologists, PLC; Charles F. Spencer, as owner of Total Family Physicians Center PLLC; and Mitchell P. Shea, as owner of Chiro2Med of Tennessee P.C., have agreed to pay the United States and Tennessee a total of $1.72 million to resolve allegations under the False Claims Act for improperly billing Medicare and TennCare for “P-Stim” electro-acupuncture devices that do not qualify for reimbursement.  The defendants billed for the disposable P-Stim devices using a code reserved for neurostimulator devices that are implanted during a surgical procedure. USAO MDTN

December 31, 2020

Department of Veterans Affairs contractor TriWest Healthcare Alliance Corp. has agreed to pay $179.7 million to resolve allegations that it improperly retained overpayments received from the VA.  TriWest administered portions of VA’s former Veterans Choice Program and its Patient-Centered Community Care Program (PC3), which enable veterans to obtain VA-paid healthcare from private providers.  At times, VA allegedly paid TriWest twice for the same services, or paid for services for which TriWest received full or partial reimbursement from other healthcare providers, and TriWest failed to return those overpayments.  DOJ

December 21, 2020

DME provider Apria Healthcare Group, Inc. and April Healthcare LLC will pay $40.5 million to settle allegations brought in a qui tam action filed by three former Apria employees that they improperly billed government healthcare programs for beneficiary rentals of non-invasive ventilators (“NIVs”) that were not medically necessary or which were provided with improper waivers of patient co-payments.  Medicare pays as much as $1,400 a month for NIVs, and providers are required to monitor patient usage of NIVs and stop billing when the NIVs are no longer being used.  Apria respiratory therapists did not, however, failed to monitor patient NIV usage and even when Apria knew that patients were no longer using the NIVs, Apria often did not take steps to stop seeking payment.  In addition, April sales staff steered doctors and beneficiaries to use NIVs when less-expensive alternatives were available, and routinely waived co-payments for NIV patients without making an assessment of the patient’s financial need.  USAO SDNY

December 21, 2020

Substance abuse treatment provider A.R.E.B.A.-CASRIEL, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (“ACI”) and its owner, Steven Yohay, agreed to pay a total of $6 million to resolve federal and New York state claims that they defrauded Medicaid including through the payment of kickbacks and other fraudulent conduct in connection with the enrollment of Medicaid beneficiaries into ACI’s inpatient treatment program.  Defendants allegedly employed drivers who were compensated in part based on the number of patients they recruited, to target homeless individuals to enroll in ACI’s inpatient treatment program by offering food, cash, and money to purchase drugs, and/or alcohol. In addition, ACI unlawfully paid a patient recruiter, and enrolled Medicaid patients who had not been evaluated by a qualified healthcare professional, including by copying a physician’s signature.  The government’s investigation was initiated by a whistleblower complaint filed by a former employee, who will receive an undisclosed amount of the settlement.  USAO SDNY; NY

December 18, 2020

Texas Heart Hospital of the Southwest LLP and its affiliate THHBP Management Company LLC will pay $48 million to resolve claims brought in a whistleblower suit by two of the hospitals’ physicians alleging that the defendants violated the False Claims Act, Stark Law, and Anti-Kickback Statute.  Agreements between the hospital and its physician-owners required the doctors to have 48 patient-contacts a year in order to maintain their ownership interests.  The U.S. did not intervene in the action; the whistleblowers, Dr. Mitchell Magee and Dr. Todd Dewey, will collectively receive $13.92 million, 29% of the total settlement, as a whistleblower reward.  DOJ
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