Healthcare Fraud Archives - Page 24 of 128

April 6, 2022

Florida hospital chain BayCare Health System Inc. will pay $20 million to resolve claims that the company knowingly caused false claims for federal Medicaid matching funds to be submitted to the United States by making improper, non-bona fide cash donations to the Juvenile Welfare Board of Pinellas County (JWB) knowing that the funds would be transferred by JWB to the State of Florida’s Agency for Health Care Administration for Florida’s Medicaid Program, which would trigger a corresponding federal matching payment. The prohibition on non-bona fide donations ensures that states are paying a share of Medicaid payments; the non-bona fide donations increased Medicaid payments received by BayCare without any actual expenditure of state or local funds and enabled BayCare to recoup its original donations to JWB and also receive federal matching funds. The case was initiated with a qui tam complaint filed by Larry Bomar, who will receive $5 million as an award for initiating the whistleblower action. DOJ; MD FL

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Whistleblower Case, Whistleblower Rewards,

March 31, 2022

Clinical laboratory Radeas LLC has agreed to pay $11.6 million to resolve claims that it submitted false claims to Medicare for medically-unnecessary urine drug tests. As part of the settlement agreement, Radeas admitted that it regularly performed and billed Medicare for essentially simultaneous presumptive qualitative drug testing and confirmatory quantitative drug testing. Without physician review of a presumptive test result, the separate, simultaneous confirmatory test was often not necessary. Radeas also admitted that it paid third-party sales organizations based on the volume of UDT referrals in violation of the Anti-Kickback Statute. USAO MA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

March 30, 2022

Multiple sales representatives of Delaware-based pharmacy, Heritage Therapeutics, LLC have been ordered to forfeit and/or pay fines totaling over $8.7 million after they were found to have paid kickbacks to physicians in exchange for prescribing expensive compounded medications to TRICARE beneficiaries. Additionally, Heritage and various executives have entered into a settlement agreement to resolve claims under the Anti-Kickback Statute and False Claims Act. USAO EDPA

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Other Government Health Programs,

March 28, 2022

A Pennsylvania-based psychiatrist and his wife have agreed to pay $3 million in the largest recovery against a single psychiatrist ever in the history of the U.S. Department of Labor – Office of Worker’s Compensation Programs (OWCP). From 2013 to 2021, Dr. Harry Doyle and his wife and sole employee, Sonya, allegedly billed OWCP for services that weren’t rendered, submitted double-billed and upcoded patient claims, and falsified patient records to reflect their false billing. As part of the settlement, they will be excluded from participating in federal healthcare programs for 25 years. USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Upcoding,

March 25, 2022

Two New York-based home health agencies, All American Homecare Agency and Crown of Life Care NY LLC, have agreed to pay a total of $5.4 million to settle allegations of violating federal and state False Claims Acts. The agencies had allegedly paid their home health aides below minimum wage, despite claiming otherwise and receiving millions for said wages from Medicaid. In addition to the monetary penalties, the agencies will also pay back wages owed to current and former aides. NY AG; USAO EDNY

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice,

March 24, 2022

A New York woman who defrauded the state out of millions of dollars has been sentenced to 3 to 9 years in prison and ordered to pay more than $4 million in restitution. According to the Attorney General’s Office, Leslie Montgomery lured low-income New Yorkers to Health Living Community Center under the guise of helping them find housing, then used their information to submit false claims to a Medicaid-funded managed care organization. The claims for custom-molded back braces were medically unnecessary and not requested by or provided to the intended recipients. Montgomery then hid the illegal proceeds through multiple shell companies, including LCM Livery P/U, Inc. NY AG

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Devices and DME, Money Laundering,

March 22, 2022

Ten doctors in Texas and a healthcare executive have agreed to pay nearly $1.7 million to resolve allegations of violating the False Claims Act, Anti-Kickback Statute, and Stark Law. In exchange for ordering laboratory tests from Rockdale Hospital d/b/a A little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation, the doctors allegedly received thousands of dollars in kickbacks disguised as investment returns. USAO EDTX

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Provider Fraud,

March 21, 2022

Jonathan and Daniel Markovich, two brothers who operate addiction treatment facilities in Florida, have been sentenced to over 15 years and 8 years in prison respectively after being convicted of running a $112 million fraud scheme. Through patient recruiters, the defendants paid illegal kickbacks to patients in the form of airline tickets, cash payments, and illegal drugs to entice them to visit their inpatient detox and residential facility, Second Chance Detox LLC d/b/a Compass Detox, as well as their outpatient treatment program, WAR Network LLC. The defendants then billed for therapy sessions that were not regularly provided to or attended by patients, and urine drug tests that were not medically necessary. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud,

March 11, 2022

California state and local entities secured a $3.25 million settlement with Brookdale Senior Living, Inc. resolving allegations that the skilled nursing facility company misrepresented its services and quality of care, fraudulently inflating the star ratings for specific Brookdale facilities in California. The government alleged that Brookdale failed to timely provide required notice to residents of transfers or discharges, and over-reported its nursing staffing hours to CMS. CA DOJ

Tagged in: Healthcare Fraud, SNF,

March 9, 2022

Sixteen defendants from Michigan and Ohio have been sentenced to prison for their roles in a massive $250 million healthcare fraud scheme that involved subjecting opioid-addicted patients to medically unnecessary back injections in exchange for more opioids. The injections were selected because they were reimbursed highly by government payors, but were often painful or led to adverse conditions, such as open holes in the back. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity,

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