Healthcare Fraud
This archive displays posts tagged as relevant to healthcare fraud.
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December 14, 2018
Tamar Tatarian, owner of Akhtmar Pharmacy, was found guilty for her part in a scheme to defraud Medicare out of more than $1.3 million in false claims for prescription drugs. According to evidence presented during the two-day trial, Tatarian submitted false claims to Medicare Part D plan sponsors between October 2015 and October 2017 for prescription drugs that Akhtmar pharmacy had not actually ordered from wholesalers, and therefore were not dispensed to Medicare beneficiaries. Tartarian tried to cover up the fraud by generating fake invoices that included wholesale drug purchases by the pharmacy which had not, in reality, ever happened. Tatarian was convicted of one count of health care fraud and two counts of wire fraud. DOJCatch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations
Posted 12/14/18
December 13, 2018
Hospice care provider SouthernCare, Inc. has agreed to pay $5,863,426 for submitting fraudulent claims to Medicare between 2009 to 2014. Under Medicare's eligibility rules, in order for hospice care to be reimbursed, a patient must have a life expectancy of six months or less as certified by a physician, and terminal illnesses must be documented with appropriate records. However, according to qui tam complaints by former employees Dawn Hamrock and Patricia Beegle, SouthernCare billed Medicare for care provided to patients who were not Medicare eligible or who had no proof of Medicare eligibility. As part of the settlement, Hamrock and Beegle will share a $1.1 million whistleblower reward. USAO EDPADecember 11, 2018
Target Corp. will pay $3 million to settle allegations that it improperly billed and received payments from the state’s Medicaid program (MassHealth). Between August 2009 and July 2015, at their Massachusetts locations, Target allowed auto-refills on prescriptions that were not clearly requested by a MassHealth patient or caregiver at the time of refill. The investigation arose from a qui tam action by an unnamed whistleblower in the United States District Court for the District of Minnesota. Mass AGDecember 11, 2018
A New York-based audiology practice has agreed to pay $566,263.08 in connection with alleged violations of the False Claims Act and Anti-Kickback Statute. According to an unnamed whistleblower, Oviatt Hearing and Balance, LLC improperly billed Medicare and TRICARE for services rendered by unlicensed and unsupervised employees, as well as provided inappropriate inducements in the form of free iPads, Butterball turkeys, and gift cards, to Medicare and TRICARE beneficiaries to get them to choose Oviatt over other providers. For their role in exposing the fraud, the whistleblower stands to receive a relator's share of $120,000. USAO NDNYDecember 11, 2018
Following qui tam complaints filed by two former employees, Western Medical Group and owners Benjamin George and Jody Rookstool have agreed to pay a total of $1,634,844 to settle allegations that the company violated the False Claims Act in submissions to Medicare. The two complaints, filed in December 2013 and February 2014, alleged that Western Medical violated Medicare's reimbursement rules by using a telemarketing company to solicit sales of knee and back braces from eligible Medicare beneficiaries. USAO UTDecember 11, 2018
Coordinated Health Holding Company, LLC, a for-profit hospital and health system, and its founder, owner, and CEO, Emil DiIorio, M.D., have agreed to pay a combined $12.5 million to settle allegations of violating the False Claims Act in claims submitted to Medicare, Medicaid, and federal employee health insurers. From 2007 until 2014, under DiIorio's direction, Coordinated Health allegedly exploited a billing code called Modifier 59 in order to separately bill for orthopedic surgery charges that, properly billed, instead fall under a single "global" payment for each surgery. Even after outside consultants warned company executives about the improper practice in 2011 and 2013 and provided on-site training on the proper use of Modifier 59, Coordinated Health continued making false claims, causing federal healthcare payers to overpay by millions of dollars. As part of the settlement, the company has signed a Corporate Integrity Agreement for additional government oversight into its billing practices over the next five years. USAO EDPADecember 11, 2018
Aurora Health Care, Inc. has agreed to pay $12 million to settle allegations of defrauding Medicare and Wisconsin's Medicaid program in certain reimbursement claims filed between 2008 to 2012. According to the United States and State of Wisconsin, the healthcare provider and two physicians entered into improper financial relationships in violation of the federal and state False Claims Acts as well as the Stark Law. As a result, some of the claims that Aurora submitted to the government health programs were improper. Despite alerting the government to the illegal arrangement, a qui tam complaint filed by unnamed whistleblowers alleged different claims. Although the whistleblowers will still receive a share of the recovery, the government did not intervene in their lawsuit, which will be dismissed as part of the settlement. USAO EDWICatch of the Week — Actelion Pharmaceticals
Posted 12/7/18
