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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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October 17, 2019

Five home health providers in Iowa and South Dakota have been ordered to pay a combined $3.1 million for submitting false claims to Medicare.  Affiliates of Minnesota-based Welcov Healthcare LLC allegedly billed Medicare for therapy services that were not provided by skilled employees or not medically necessary.  Sergeant Bluff Healthcare, LLC will pay over $1.2 million, Logan Healthcare, LLC and Elk Point Healthcare #1, LLC will each pay over $775,000, Red Oak Healthcare, LLC will pay over $228,000, and Flandreau Healthcare 2, LLC will pay about $116,000.  USAO NDIA

October 15, 2019

Otolaryngologist Dr. Tracey Wellendorf has agreed to pay $1 million to resolve allegations of violating the False Claims Act in at least 115 procedures billed to Iowa Medicaid.  The alleged misconduct occurred between 2014 and 2015 and involved endoscopic sinus surgeries that were either medically unnecessary or incorrectly coded.  USAO NDIA

October 10, 2019

Traverse Anesthesia Associates, P.C. (TAA) and six of its anesthesiologists have agreed to pay $607,966 to resolve a partially-intervened qui tam lawsuit jointly filed by two former employees.  In violation of the False Claims Act, TAA allegedly failed to meet regulatory requirements and conditions of payment in submissions to Medicare.  The unnamed whistleblowers will share a $120,000 award.  USAO WDMI

October 9, 2019

Genetic testing company UTC Laboratories, Inc. (RenRX), along with three principals, have agreed to pay a combined $42.6 million to settle six suits alleging violations of the Anti-Kickback Statue and False Claims Act.  Between 2013 and 2017, RenRX and principals Tarun Jolly, M.D., Patrick Ridgeway, and Barry Griffith allegedly paid cash bribes to physician entities and individuals to induce orders of medically unnecessary pharmacogenetic tests that were subsequently billed to Medicare.  As part of the settlement, RenRX also agreed to a twenty-five year period of exclusion from participating in any federal healthcare program.  USAO EDLA

October 9, 2019

The largest operator of kidney dialysis clinics in the United States has agreed to pay $5.2 million to resolve a lawsuit alleging it submitted false claims to Medicare for excessive and unnecessary immune tests.  From 2013 to 2010, Fresenius Medical Care Holdings, Inc. allegedly billed Medicare for Hepatitis B surface antigen tests it performed on patients already known to be immune, at a frequency well above that established by Medicare.  For exposing the alleged False Claims Act violations, former employee Christopher Drennen will receive a 27.5% share of the recovery.  USAO MA

October 4, 2019

Florida man Brock Lovelace has been sentenced to nearly six years in federal prison following his conviction at trial on charges related to his payment of kickbacks to medical clinics in the Miami area in exchange for the clinics providing him with DNA samples for submission to a DNA testing laboratory between 2013 and 2014.  Lovelace requested that the medical clinics collect the DNA of all the patients who visited the clinics; in turn, the clinics provided food and other inducements to beneficiaries to get them to visit.  Lovelace then submitted the DNA swabs to a testing lab, which billed Medicare.  The patients were not provided with the results of the DNA testing, and typically did not have any medical need for the DNA testing.  Lovelace was previously sentenced to 14 years in prison on other healthcare fraud charges; he will serve the present sentence consecutively.  DOJ

October 4, 2019

Southern California-based Retina Institute of California Medical Group (RIC), its former CEO, and several of its physicians have agreed to pay the State of California and United States $6.65 million to settle alleged violations of state and federal False Claims Acts.  According to former administrators Bobbette Smith and Susan Rogers, between 2006 and 2017, the ophthalmology group improperly billed Medicare and Medicaid for unnecessary and unperformed eye exams, upcoded simple exams using codes normally reserved for emergency conditions, and waived mandatory co-payments and deductibles to induce patient referrals.  Smith and Rogers will receive a relator’s share, which remains to be determined.  USAO CDCA

October 3, 2019

Glenn A. Kline and Community Surgical Associates of Lancaster, Pennsylvania, will pay $4.25 million to resolve claims that Dr. Kline entered into an unlawful kickback arrangement with two hospitals owned by Health Management Associates in exchange for his referral of patients to the hospitals.  The hospitals paid Dr. Kline far above fair market value for his services, and made additional payments to Community Surgical Associates, structuring those payments to conceal their purpose.  HMA previously paid $260 million to resolve related claims; physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million; and, former HMA CEO Gary Newsome agreed to pay $3.5 million.  The claims against Kline and Community Surgical were original made in a qui tam complaint filed by former HMA executives George Miller and Michael Metts; they will receive $1.05 million of the settlement.  USAO ED PA

September 27, 2019

Meridian Mobile Health, L.L.C., based in Bangor, Maine and doing business as Capital Ambulance, will pay $138,300 to resolve claims that it violated the False Claims Act by billing Medicare for non-emergency transportation.  The ambulance company, which voluntarily disclosed the billings to the U.S. Attorney's office, claimed that it had been provided with incorrect and/or incomplete information from Eastern Maine Medical Center regarding discharged patients in need of transportation.  USAO ME
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