Healthcare Fraud

January 25, 2017

Rodney Hesson and Gertrude Parker, owners of several psychological services companies, were convicted for their involvement in a $25.2 million Medicare fraud scheme carried out through eight companies at nursing homes in four states in the Southeastern United States.  According to evidence presented at trial, the defendants’ companies contracted with nursing homes for psychological testing services the nursing home residents did not need or did not receive.  DOJ

January 12, 2017

Idia Oriakhi, the administrator of five Houston-area home health agencies, pleaded guilty to conspiring to defraud the State of Texas’ Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. Oriakhi’s parents owned and operated Aabraham Blessings, LLC; Baptist Home Care Providers, Inc.; Community Wide Home Health, Inc.; Four Seasons Home Healthcare, Inc. and Kis Med Concepts, Inc. and admitted that she, her father Godwin Oriakhi and others obtained patients for her family’s home health agencies by paying illegal kickback payments to patient recruiters and physicians for referring and certifying Medicaid patients for services not medically necessary and often not provided. DOJ

January 12, 2017

Connecticut home healthcare provider Family Care Visiting Nurse and Home Care Agency, LLC and its owners David A. Krett and Rita C. Krett agreed to pay roughly $5.25 million to resolve allegations they violated the False Claims Act by billing for services which under Medicaid required a registered nurse when in fact a registered nurse did not provide the services. The government further alleged the company submitted claims to Medicaid for patients who were or may have been dually eligible for Medicare and Medicaid without first following required procedures for submitting claims to Medicare. DOJ (DCT)

January 12, 2017

The Confederated Tribes of the Colville Reservation (CGT) agreed to pay roughly $246,000 to settle charges it violated the False Claims Act by submitting false claims to Medicaid seeking the reimbursement of mental health counseling services either not provided or not medically indicated or necessary. The CCT is a federally recognized, sovereign Indian tribe, with tribal offices located at Nespelem, Washington, on the Tribes’ reservation. DOJ (EDWA)

January 11, 2017

Ireland-based Shire Pharmaceuticals LLC and certain subsidiaries agreed to pay $350 million to settle charges that Shire and the company it acquired in 2011, Advanced BioHealing violated the False Claims Act and Anti-Kickback Statute by using kickbacks and other unlawful methods to induce clinics and physicians to use or overuse their “Dermagraft” skin product. It is the largest False Claims Act recovery in a kickback case involving a medical device, and resolves claims brought by the federal government along with 37 states and the District of Columbia. The States will receive $6,104,000 for the State share of the Medicaid program. According to the government, Dermagraft salespersons unlawfully induced clinics and physicians with lavish dinners, drinks, entertainment and travel; medical equipment and supplies; unwarranted payments for purported speaking engagements and bogus case studies; and cash, credits and rebates. The allegations originated in six lawsuits filed brought by whistleblowers in, or transferred to, the United States District Court for the Middle District of Florida. Two of the qui tam actions named New York and other states and included allegations that Shire submitted or caused to be submitted false claims to the Medicaid program under federal and state False Claims Acts. The whistleblowers will receive a yet-to-be-determined whistleblower award from the proceeds of the government recovery. Whistleblower Insider, NY, FL

January 9, 2017

Detroit-area neurosurgeon Aria O. Sabit was sentenced to 235 months in prison for his role in a $2.8 million health care fraud scheme in which he caused serious bodily harm to patients by performing unnecessary invasive spinal surgeries. Sabit owned and operated the Michigan Brain and Spine Physicians Group. He admitted deriving significant profits by convincing patients to undergo spinal fusion surgeries with “instrumentation” (medical devices designed to stabilize and strengthen the spine) that he never performed and billed public and private healthcare benefit programs for those fraudulent services. Whistleblower Insider

January 12, 2017

New York announced the indictment and arraignment of attorney Anthony Cornachio, 74, of Garden City as well as the indictment and arraignment of NRI Group, LLC. (“NRI”) and Canarsie A.W.A.R.E., Inc. (“Canarsie”), both Medicaid-enrolled drug treatment programs companies controlled by Cornachio. Also announced was the indictment and arraignment of three-quarter housing operators Yury Baumblit, 66, and Rimma Baumblit, 60, of Brooklyn, and their company Back on Track Group, Inc. In papers unsealed in New York State Supreme Court, Kings County, prosecutors allege that Yury Baumblit and Rimma Baumblit, in exchange for payments from Cornachio’s companies, forced residents of their three-quarter homes to attend treatment at NRI and Canarsie regardless of the residents’ actual need for drug treatment services or face eviction. All of the residences leased by Back on Track Group, Inc. and operated by Yury Baumblit and Rimma Baumblit as three-quarter homes were located in Kings County. During the course of this scheme, which dates back to at least 2013, Cornachio allegedly paid Back on Track Group, Inc. over $900,000.00 in illegal kickbacks. As a result of this kickback scheme, prosecutors allege that Cornachio, through NRI and Canarsie, submitted, and caused to be submitted, at least $1.7 million in false claims for reimbursement to Medicaid. These claims, prosecutors allege, were fraudulent because they resulted from illegal kickbacks and were often medically unnecessary. NY

$2.6 Million Whistleblower Settlement With Bay Sleep Clinic

The clinic will settle whistleblower allegations of using unlicensed technicians and unapproved locations and of doctor kickback referrals. Constantine Cannon LLP is pleased to announce a $2.6 million settlement on behalf of its client for whistleblower allegations against Bay Sleep Clinic. The settlement was announced by the United States government on December 28, 2016, against Bay Sleep Clinic, which currently operates 20 locations throughout northern California; its related Qualium Corporation and Amerimed Corporation businesses; and owners and operators Anooshiravan Mostowfipour and Tara Nader. The “qui tam,” or whistleblower, lawsuit alleged that the defendants fraudulently billed Medicare for sleep studies conducted by unlicensed individuals in unapproved locations; improperly dispensed durable medical equipment from unapproved locations using unlicensed technicians; and paid doctors for referrals in violation of the federal Anti-Kickback Statute. The defendants neither admitted nor denied liability. The whistleblower, Elma F. Dresser, is a former Bay Sleep Clinic employee who worked as a sleep technician and marketer for eight years. Through her various roles at the company, Ms. Dresser became familiar with the defendants’ alleged scheme to bilk money from Medicare. She filed her suit in 2012, leading the government to investigate the claims and join the case. Ms. Dresser was represented by Eric R. Havian, partner and attorney, Jessica T. Moore, partner and attorney, Anne Hayes Hartman, partner and attorney, Hallie Noecker, attorney, and Sarah Poppy Alexander, attorney of Constantine Cannon’s whistleblower practice in San Francisco, along with co-counsel from the Law Office of William C. Dresser. “It’s rewarding to see the alleged fraudsters held responsible. Because of the close cooperation and work between the whistleblower and the government, we were able to recover significant funds for the government,” said Anne Hayes Hartman, co-lead counsel on the case. “It is gratifying to represent people like Elma Dresser, who bravely stepped forward with knowledge of her employer’s wrongdoing. Many do not appreciate the risks whistleblowers face to hold alleged wrongdoers accountable.” “Sleep studies are a quickly expanding medical field,” said Jessica T. Moore, who served as co- lead counsel on the case. “Ensuring the safety of these procedures should be a top priority of the government for all patients, Medicare and otherwise.” The federal False Claims Act allows whistleblowers to sue companies that are defrauding the government and receive a reward if the government recovers any funds as a result. The government may choose to intervene in the lawsuit, as it has done in this case. The False Claims Act is one of the government’s most effective weapons in combatting fraud, waste, and abuse by those who contract with the government. Healthcare fraud alone is estimated to cost the U.S. billions of dollars. Such fraud can be difficult to discern without access to inside information; well-placed whistleblowers are necessary to provide the information the government might otherwise lack to help stop these practices.