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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 18 of 128

August 30, 2022

Vision Quest Industries, Inc., which manufactures knee braces and other durable medical equipment, has agreed to pay $2.25 million to resolve claims that it violated the Anti-Kickback Statute by paying commissions to an independent sales representative based on VQ’s net revenue for each knee brace ordered by a particular purchaser which then, in turn, submitted claims for payment to Medicare.  The settlement with VQ follows earlier settlements in 2020 and 2019.  USAO MN

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medical Devices and DME,

August 24, 2022

Centene will pay Washington State $19 million to resolve allegations that the company overcharged the state for pharmacy benefit management services.  The state alleged that Centene failed to pass on discounts it received to the state Medicaid program, and inflated dispensing fees.  WA

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

Telehealth Boomed During the Pandemic - and so Did Telehealth Fraud

Posted  08/24/22
Doctor with stethoscope on computer screen
Prior to the pandemic, telehealth was basically nonexistent, with one study clocking the percentage of “virtual” doctors’ visits before Covid-19 at zero percent. At the time, America’s largest insurer, Medicare, only covered telemedicine in limited circumstances that usually still involved a visit to a healthcare facility. Medicare’s coverage limitations demonstrated the Department of Health and Human...

Tagged in: COVID-19, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Provider Fraud,

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August 23, 2022

Texas-based Cockerell Dermatopathology (CDP) has agreed to pay $3.75 million to resolve allegations of allowing millions of dollars in fraudulent claims to be submitted to TRICARE, in violation of the False Claims Act.  According to a government suit, CDP’s principal physician, Dr. Clay Cockerell, had allowed laboratory management company Progen to use its license to submit false claims for medically unnecessary tests in exchange for a twenty percent cut of the proceeds.  USAO NDTX

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Other Government Health Programs,

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,

August 11, 2022

Spivack, Inc., formerly operating as Verree Pharmacy, and owner-pharmacist Mitchell Spivack, have agreed to pay over $4.1 million in civil penalties for dispensing opioids despite numerous red flags the drugs were being diverted—all in violation of the False Claims Act and the Controlled Substances Act. In furtherance of the fraud, Spivack made false statements to drug distributors to maintain the façade of legitimacy, while concurrently drawing millions from the pharmacy and harming the public. In addition to their opioid fraud, Spivack and Verree effectuated their “Bill But Don’t Fill” scheme, where they would enter “BBDF” in their internal computer system, and would submit false claims to insurers for drugs not actually dispensed. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud,

August 10, 2022

American Senior Communities, L.L.C., will pay over $5.5 million for violating the False Claims Act by charging Medicare directly for hospice services that should have already been covered by the beneficiaries’ Medicare hospice coverage. The fraudulent billing practice was exposed in a whistleblower complaint filed by a former employee of a hospice services provider that worked with ASC. The whistleblower is entitled to receive between 15 and 25% of the recovery. USAO SDIN

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicare, SNF, Whistleblower Rewards,

August 4, 2022

Eastern Iowa Dermatology, PLC and Dr. Manish Kumar will pay $1.66 million for violating the False Claims Act. Defendants submitted up-coded claims to Medicare for office visits and destruction or removal of skin tags and lesions, the sole purpose of which is to increase Medicare’s reimbursement rate. In addition to the monetary penalty, they agreed to an Integrity Agreement and are subject to ongoing monitoring by the US DHHS. USAO SDIA

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Provider Fraud, Upcoding,

August 3, 2022

North Country Neurology, P.C. will pay $850,000 for violating the False Claims Act by submitting claims falsely listing a physician as the service provider, when the services were provided instead by an unsupervised non-physician practitioner. Medicare will reimburse for certain services provided by NPPs, but require a physician to be physically present in the office and immediately available to furnish assistance. This was not the case on over 120 occasions, and NCN admitted it should have known it was improper to bill at the higher physician rather than NPP level. Additionally, NCN improperly billed Medicare on approximately 761 occasions for Botox, even though it had already been paid for by another insurer. NCN blamed their insufficient compliance program for the errors. USAO NDNY

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medical Billing Fraud, Medicare, Provider Fraud, Upcoding,

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