Improper Medical Personnel

February 13, 2018

Detroit-area doctor Mahmoud Rahim was sentenced to 72 months in prison and ordered to forfeit roughly $1.7 million for his role in a $10.4 million conspiracy to defraud the Medicare program. According to the evidence presented at trial, Rahim accepted kickbacks in exchange for referring Medicare patients for electromyogram tests, some of which were unnecessary, and physical therapy performed by unlicensed individuals. DOJ

January 29, 2018

A judgment of roughly $16 million was entered against Orthopaedic and Neuro Imaging LLC for violating the False Claims Act by submitting claims for contrast dye MRI scans not properly supervised by a physician. DOJ (DE)

January 31, 2018

New York announced that Home Family Care, Inc. ("Home Family") of Brooklyn, NY and its President, Alexander Kiselev, will pay $6.415 million to resolve allegations that they violated the federal and New York False Claims Acts by falsely billing the New York State Medicaid program for home health care services that were not provided or that were provided by unqualified staff. The settlement resolves allegations in a complaint filed by the State of New York and the United States that Home Family routinely permitted its aides to circumvent verification procedures purportedly put in place by Home Family to ensure that its aides were providing scheduled services to Medicaid recipients who depended upon them. As alleged in the complaint, even after Home Family put in place an electronic attendance verification system which purportedly required aides to call a central number to "clock in" and "clock out" of their shifts before their services could be billed, Home Family aides routinely ignored this requirement and failed to clock in or out of their shifts – yet were still paid for them. NY

January 19, 2018

San Diego-based health care system Scripps Health agreed to pay $1.5 million to resolve allegations it violated the False Claims Act by charging federal health care programs for physical therapy services that were rendered by therapists who did not have billing privileges for these programs and were not supervised by an authorized provider. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Scripps employee Suzanne Forrest. She will receive a whistleblower award of $225,000 from the proceeds of the government's recovery. DOJ

December 29, 2017

Maryland physician Nwaehihie H. Onyeaghala of Krystal Medical Associates, LLC agreed to pay $1 million to settle allegations he violated the False Claims Act by submitting false claims to Medicare for medically unnecessary autonomic nervous function tests and peripheral vascular tests.  According to the government, the tests were not medically necessary because Dr. Onyeaghala lacked the necessary equipment to conduct the tests, the patients did not have an autonomic nervous function disorder before the test was conducted, Dr. Onyeaghala lacked the specific training to conduct such tests and he only used the tests to monitor patient symptoms, not make any clinical decisions about future patient care.  DOJ (DMD)

September 27, 2017

South Carolina hospital AnMed Health agreed to pay over $7 million to resolve allegations it violated the False Claims Act by knowingly disregarding the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.  Specifically, the government alleged that AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former AnMed Health employee Linda Jainniney.  She will receive a whistleblower award of roughly $1.2 million from the proceeds of the government's recovery.  DOJ (NDGA)

September 15, 2017

Valentina Kovalienko, the owner of Brooklyn medical clinics Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. was sentenced to 84 months in prison and ordered to forfeit roughly $29 million for her role in a $55 million health care fraud scheme.  As part of her guilty plea, Kovalienko acknowledged that her co-conspirators paid cash kickbacks to patients to induce them to attend her two clinics.  She also admitted submitting false and fraudulent claims to Medicare and Medicaid for services that were induced by prohibited kickback payments to patients or that were unlawfully rendered by unlicensed staff. DOJ

September 7, 2017

Connecticut substance abuse treatment provider the Hartford Dispensary and the Hartford Dispensary Endowment Corporation and its former CEO Paul McLaughlin agreed to pay $627,000 to resolve allegations they violated the False Claims Acts by falsely representing and certifying to federal and state authorities that Hartford Dispensary had a medical director, as defined by relevant regulations, who was performing the duties and responsibilities required by federal and state law.  The allegations originated in a whistleblower lawsuit filed by former Hartford Dispensary employees Russell Buchner and Charles Hatheway under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $113,000 from the proceeds of the government's recovery.  DOJ (DCT)