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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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January 5, 2024

A Florida man, Karel Felipe, and Florida woman, Tamara Quicutis, have been sentenced to 8 years and 5 years respectively for their roles in a $93 million fraud scheme against Medicare.  Felipe and Quicutis were found guilty last October of submitting claims on behalf of three Michigan-based home health companies, for services never rendered, using stolen patient information, and then laundering the proceeds through dozens of shell companies and hundreds of bank accounts.  Their fellow co-conspirators—Jesus Trujillo, Didier Arcia, Alexey Gil, and Jeffrey Avila—have already been sentenced for their roles.  DOJ

Catch of the Week: Moffitt Cancer Center

Posted  01/5/24
medicare dollars
This week's Department of Justice (DOJ) Catch of the Week goes to Tampa-based H. Lee Moffitt Cancer Center & Research Institute Hospital.  Yesterday (January 4), the non-profit cancer treatment and research center agreed to pay roughly $19.6 million to settle DOJ charges of violating the False Claims Act by billing Medicare for patient care services provided during research studies not eligible for...

January 4, 2024

ChristianaCare has paid $42.5 million for violations of the federal False Claims Act and the Delaware False Claims and Reporting Act. In a qui tam whistleblower complaint filed in 2017, ChristianaCare's former chief compliance officer alleged illegal remuneration was provided to non-employee neonatologists and surgeons in the form of free or below fair market services by ancillary support providers, such as nurse practitioners, hospitalists, and physician assistants. These services were meant to induce referrals from the non-employees, creating a financial relationship. USAO DE

January 4, 2024

Florida-based H. Lee Moffitt Cancer Center & Research Institute Hospital Inc. (Moffitt) has agreed to pay over $19.5 million to resolve allegations of violating federal and state False Claims Acts over a 6-year period.  A majority of the settlement proceeds, $18.2 million, will go to the federal government, while $1.3 million will go to the State of Florida.  The hospital allegedly billed the government for items and services that should have been billed to non-government sponsors.  DOJ

December 22, 2023

Christiana Care Health System has agreed to pay over $7.6 million to the State of Delaware for violating the federal and state False Claims Acts, and Delaware’s Patient Brokering and Anti-Kickback laws.  According to a qui tam whistleblower, who filed a case in 2017, the healthcare system provided free or below-market rate support services to doctors in exchange for referrals of Medicaid patients, then submitted false claims stemming from those referrals to Delaware’s Medicaid program.  DE AG

Community Health Network Pays $345 Million to Settle Stark Law Case

Posted  12/21/23
Handshake in room with dark window blinds
Community Health Network Inc., based in Indianapolis, recently settled with the U.S. government for $345 million, addressing allegations under the False Claims Act related to the Stark Law. This landmark case emphasizes the importance of whistleblowers to combat Medicare fraud. The Stark Law prevents hospitals from billing Medicare for services referred by physicians who have a financial relationship with the...

December 21, 2023

A Florida woman who submitted over $192 million in claims to Medicare for medically unnecessary and unprovided tests, equipment, and services, has been sentenced to 20 years in prison.  Elizabeth Hernandez ordered thousands of genetic testing and orthotic braces for patients she never spoke to or examined, ultimately ordering more cancer genetic tests than any other provider in the nation.  She also billed for thousands of telemedicine visits that she never performed, often billing for over 24 hours in a single day.  DOJ

December 21, 2023

Ultragenyx Pharmaceutical, Inc., maker of Crysvita, will pay $6 million for violating the False Claims Act. Crysvita is prescribed to treat a rare inherited blood disorder, which may require a genetic test to definitively diagnose. To induce purchases and referrals, Ultragenyx paid a laboratory to conduct genetic tests at no cost to healthcare providers or patients, and then provide the results reports to Ultragenyx. Ultragenyx then used the positive test results reports to target healthcare providers for Crysvita sales. Internally, Ultragenyx referred to this kickback scheme as their "sponsored" testing program. The program was exposed via a qui tam whistleblower, who will receive $1.07 million of the $6.7 million recovery. DOJ

December 21, 2023

Armando Herrera was sentenced to 51 months in prison for distributing at least $16.7 million worth of adulterated and misbranded prescription HIV drugs. Herrera and his co-conspirators operated companies in four states, creating false documentation to then pass off the drugs as legitimately acquired, and then sold to unwitting pharmaceutical suppliers who, in turn, sold them to unsuspecting HIV patients. DOJ

December 19, 2023

Indiana-based Community Health Network Inc. has agreed to pay $345 million to resolve claims by its former CFO and COO Thomas Fischer, which alleged the healthcare system submitted claims to Medicare that were tainted by violations of the Stark Law.  In order to capture physicians’ downstream referrals, Community paid physicians salaries that were sometimes double market rate, and awarded them bonuses based on the number of referrals.  Community then submitted claims resulting from these referrals for reimbursement.  DOJ
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