Healthcare Fraud

September 13, 2023

Texas-based Oliver Street Dermatology Management LLC, which manages dermatology practices, surgical centers, and pathology labs across the country, has agreed to pay $8.9 million to resolve self-reported violations of the Anti-Kickback Statute, Stark Law, and False Claims Act.  The company revealed in 2021 that some of its former senior managers had fraudulently increased the purchase price of 11 dermatology practices acquired between 2013 and 2018 in exchange for referrals.  Claims arising from those referrals were found to have been submitted to Medicare.  USAO NDTX

September 8, 2023

Grocery store chain Kroger, which owns and operates a number of subsidiaries, has agreed to pay $1.37 billion to a number of states, including California, Illinois, North Carolina, Oregon, Tennessee, and Virginia.  The settlement in principle would absolve Kroger for its role in the opioid crisis.  CA AG; NC AG; OR AG

August 31, 2023

Watermark Retirement Communities LLC, which manages 79 retirement homes across the country, has agreed to pay $4.25 million to settle claims of violating the Anti-Kickback Statute and False Claims Act.  According to a lawsuit launched by David Freeman, the former director of strategic growth for a nationwide home health agency (HHA), between 2014 and 2020, Watermark solicited and received kickbacks from the HHA in exchange for referrals of Medicare beneficiaries from 8 of its retirement facilities in 5 states, including Arizona, Connecticut, Delaware, Florida, and Pennsylvania.  Watermark then caused false claims to be submitted in connection with those referrals.  DOJ

August 30, 2023

Lompoc Valley Medical Center (LVMC) has agreed to pay $5 million to resolve allegations of causing false claims to be submitted to California’s Medicaid program.  Under the Patient Protection and Affordable Care Act (ACA), Medi-Cal received federal funds to expand coverage to previously uninsured adults.  However, LVMC knowingly claimed and received payments from the government for services that were duplicative, not reimbursable, or not priced at fair market value.  CA AG

August 21, 2023

To resolve criminal charges of colluding to fix prices, mainly on a cholesterol medicine called pravastatin, Teva Pharmaceuticals USA, Inc. has agreed to pay a $225 million criminal penalty and donate $50 million in drugs to humanitarian organizations, while Glenmark Pharmaceuticals Inc., USA has agreed to pay $30 million criminal penalty.  The drugs that Teva has been ordered to donate, clotrimazole and tobramycin, were also part of the price fixing scheme.  DOJ

August 18, 2023

A doctor who defrauded California’s Medicaid program of over $20 million has been sentenced to 5 years in jail, ordered to pay $2.3 million in restitution, and forced to surrender his medical license.  Mohamed Waddah El-Nachef had pleaded guilty to prescribing medically unnecessary anti-psychotics, HIV medications, and opioids to over a thousand Medi-Cal beneficiaries, many of whom then sold the drugs for cash.  CA AG