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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 7 of 126

August 18, 2023

The owner and operator of Georgia-based LabSolutions LLC has been sentenced to 27 years in prison for submitting over $463 million in medically unnecessary genetic and other laboratory tests derived from illegal kickbacks.  Minal Patel allegedly paid kickbacks to telemarketing companies to talk Medicare beneficiaries into getting the tests, then paid kickbacks to telemedicine doctors who signed orders for the tests without ever speaking to beneficiaries to determine need.  As a result of these fraudulent actions, Medicare paid over $187 million in reimbursement, with Patel receiving over $21 million personally, between 2016 and 2019.  DOJ

August 8, 2023

Pharmaceutical drug manufacturers Shire PLC, Baxter International Inc., Baxalta Inc., Viropharma Inc., Takeda Pharmaceuticals U.S.A., Inc., and Takeda Pharmaceuticals America have agreed to pay more than $42 million to settle a qui tam suit alleging violations of the Texas Medicaid Fraud Prevention Act.  According to an unnamed whistleblower, the companies allegedly directly or indirectly provided payments or nursing services to Medicaid providers in exchange for referrals or recommendations of a particular drug.  TX AG

August 4, 2023

Aspirar Medical Lab LLC and owner Pick Chay have agreed to pay almost $2 million to resolve allegations of defrauding the North Carolina Medicaid program.  The company allegedly paid two other companies for referring medically unnecessary urine drug tests to it, then submitted claims stemming from these illegal kickbacks to Medicaid.  NC AG

August 1, 2023

A now defunct clinical laboratory in Texas, BestCare Laboratory Services LLC, and its owner, Karim Maghareh, have agreed to pay another $5.7 million on top of nearly $800,000 already paid to the government to resolve an outstanding obligation under a 2018 judgment for violating the False Claims Act.  The underlying lawsuit, filed in 2008 by whistleblower Richard Drummond, alleged that BestCare billed Medicare for travel by lab technicians that did not reflect the actual mileage traveled.  DOJ

July 31, 2023

The distributors of a product marked as a quick and easy way to quit smoking has been ordered to pay over $7 million in restitution as well as a $500,000 civil penalty.  Michael Connors and his companies ProTouch Marketing LLC (d/b/a Smart Day Supplements), Woodford Hills LLC, Oakhill Research LLC, Evergreen Marketing LLC, Sterling Health LLC, and Clara Vista Media LLC allegedly repeatedly violated the Federal Trade Commission (FTC) Act and the Opioid Addiction Recovery Fraud Prevention Act of 2018 by making misleading claims about their Smoke Away tablets, pellets, and homeopathic sprays, which were said to eliminate nicotine cravings and withdrawal symptoms.  DOJ

July 31, 2023

Martin’s Point Health Care Inc. in Maine has agreed to pay almost $22.5 million to resolve a lawsuit by a former manager in its Risk Adjustment Operations group, which alleged the health plan administrator defrauded Medicare over a three year period.  The former manager, Alicia Wilbur, alleged that Martin’s Point reviewed charts for their Medicare Advantage beneficiaries to identify additional diagnosis codes, then submitted those codes in claims to Medicare in order to increase reimbursements even though they were not properly supported by patient medical records.  For blowing the whistle on this misconduct, Wilbur will receive a $3.8 million award.  DOJ

District Court Rules that Broad Measure of Damages Applies in False Claims Act Case, Greatly Increasing Defendants’ Exposure

Posted  07/21/23
Massachusetts State Capitol Building
Several aspects of the federal False Claims Act incentivize the government and relators to bring fraud claims to recover damages to the government.  In addition to awarding relators typically between 15% and 30% of the proceeds of the action or settlement; awarding reasonable attorneys’ fees, expenses, and costs; and applying statutory penalties for each false claim submitted; the act also provides for treble...

July 14, 2023

Electronic health record technology vendor NextGen Healthcare Inc. has agreed to pay $31 million to resolve a whistleblower’s allegations that it misrepresented the capabilities of certain software and improperly induced users to recommend the software.  According to two users of the NextGen’s software, Toby Markowitz and Elizabeth Ringgold, the company allegedly violated the False Claims Act by concealing from a certifying entity that its technology lacked critical but required functions. Additionally, the company allegedly violated the Anti-Kickback Statute by giving credits worth up to $10,000 to customers whose recommendation of NextGen’s EHR software led to a new sale.  For launching a successful qui tam case, the whistleblowers will receive and share a $5.6 million share of the recovery.  DOJ

Catch of the Week: NextGen Healthcare

Posted  07/14/23
Medical Records Review
This week's Department of Justice (DOJ) Catch of the Week goes to electronic health record (EHR) technology vendor NextGen Healthcare Inc.  Today, DOJ announced the company has agreed to pay $31 million to settle charges it violated the False Claims Act by misrepresenting to the government the capabilities of its EHR software and providing kickbacks to its users to induce them to recommend NextGen’s software.  The...

July 11, 2023

The owner of one of California’s largest chains of pain management clinics has agreed to pay nearly $11.4 million to the federal government and the states of California and Oregon to settle allegations of defrauding Medicare and state Medicaid programs of millions of dollars.  A nearly four-year investigation by government data analysts found that Dr. Francis Lagattuta and his business, Lags Medical Clinics—which operates more than 20 facilities in California and Oregon—billed the healthcare programs for medically unnecessary tests and procedures that were provided to every patient as part of clinic protocols.  The investigation also found that patients who did not consent to such procedures had their pain medication reduced.  Furthermore, a respiratory therapist who was the spouse of an executive was recruited to interpret certain test results despite having no formal medical training.  In addition to the monetary penalty, Dr. Lagattuta is also barred from serving Medi-Cal beneficiaries for the next five years.  CA AG
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