Laboratory and IDTF Archives - Page 14 of 15

January 8, 2016

Dr. David G. Bostwick, owner of Virginia-based pathology lab Bostwick Laboratories Inc., agreed to pay up to $3.75 million to resolve charges of violating the False Claims Act for billing Medicare and Medicaid for medically unnecessary cancer detection tests and offering incentives to physicians to obtain Medicare and Medicaid business. Specifically, Dr. Bostwick allegedly directed Bostwick Laboratories to bill Medicare and Medicaid for expensive cancer detection tests known as Fluorescent In Situ Hybridization (FISH) tests, as well as other tests, that were not medically necessary and were performed without the treating physicians’ consent or order. FISH tests are used to detect bladder cancer. Bostwick also allegedly offered various discounts and billing arrangements to treating physicians to induce them to refer business in violation of the Anti-Kickback Statute. On Aug. 28, 2014, Bostwick Laboratories previously agreed to pay over $6.5 million to resolve the allegations in this lawsuit. The allegations were originally raised in a whistleblower lawsuit brought by Michael Daugherty, who works in the industry, under the qui tam provisions of the False Claims Act. Daugherty will receive a whistleblower award of over $2.5 million from the government’s settlements. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

January 4, 2016

Hovik Simitian, the former owner and operator of three medical clinics located in Los Angeles — Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic — was sentenced to 78 months in prison for his role in submitting more than $4.5 million in fraudulent claims to Medicare. Simitian admitted paying illegal cash kickbacks to patient recruiters who brought Medicare beneficiaries to the clinics and for billing Medicare for lab tests and other services that were not medically necessary or actually provided, which he supported with false documentation. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud,

December 22, 2015

A physician’s assistant was sentenced to prison, and a doctor admitted taking bribes in connection with a long-running test referral scheme operated by New Jersey-based Biodiagnostic Laboratory Services LLC, its president and numerous associates. Leonard Marchetta was sentenced to 42 months in prison and Bret Ostrager pleaded guilty to conspiracy to violate the Anti-Kickback Statute and the Federal Travel Act by accepting bribes. They are two of the 39 people – 26 of them doctors – who have pleaded guilty in connection with the bribery scheme, which have involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and various private insurance companies. It is believed to be the largest number of medical professionals ever prosecuted in a bribery case. The investigation has to date recovered more than $12 million through forfeiture. DOJ (DNJ)

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF,

December 18, 2015

21st Century Oncology, a Florida-based provider of integrated cancer care services, agreed to pay $19.75 million to resolve allegations it violated the False Claims Act by billing federal health care programs for laboratory tests that were not medically necessary. The tests involved were fluorescence in situ hybridization (or “FISH”) tests which are laboratory tests performed on urine that can detect genetic abnormalities associated with bladder cancer. The government alleged that 21st Century submitted claims for unnecessary FISH tests that were ordered by four of its urologists, Dr. Meir Daller, Dr. Steven Paletsky, Dr. David Spellberg and Dr. Robert Scappa. The government further alleged the company encouraged these physicians to order unnecessary FISH tests by offering bonuses that were based in part on the number of tests referred to 21st Century’s laboratory. The allegations first arose in a whistleblower lawsuit filed by a former 21st Century medical assistant under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of $3.2 million from the proceeds of the government’s recovery. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 1, 2015

Wisconsin-based Pharmasan Labs, Inc., its related billing company NeuroScience, Inc. and their founders, Gottfried and Mieke Kellermann, agreed to pay $8.5 million to resolve charges they violated the False Claims Act by (i) submitting false information for laboratory services, and (ii) violating Medicare rules for services referred by non-physician practitioners. According to the government, and as admitted by Pharmasan under the settlement, Pharmasan falsely billed Medicare for ineligible food sensitivity testing; knew Medicare prohibited payment for such testing; and submitted false information to Medicare to disguise the type of test it was performing so Medicare would cover it. Pharmasan also admitted violating Medicare billing rules which bar payment for lab services referred by non-physicians. The government investigation leading to the settlement originated from a whistleblower action filed under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of roughly $1.1 million from the government’s recovery. Whistleblower Insider

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

November 30, 2015

Piedmont Pathology Associates, Inc. and Piedmont Pathology, P.C., a North Carolina-based diagnostic anatomic pathology group agreed to pay $500,000 to settle allegations it violated the False Claims Act and Anti-Kickback Statute by engaging in improper financial relationships with referring physicians. The allegations first arose in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former contract salesperson for the practice who witnessed a program where the practice would provide Electronic Medical Record software licenses to various physicians’ practices in exchange for referrals. The whistleblower will receive a whistleblower award of $75,000 out of the proceeds of the government’s recovery. DOJ(NC)

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

November 16, 2015

HCA Holdings, Inc. (including affiliated entities Hospital Corporation of America; Parallon Business Solutions, LLC; West Florida Regional Medical Center, Inc.; HCA Health Services of Florida, Inc.; Regional Medical Center Bayonet Point; HCA Health Services of Florida, Inc.; New Port Richey Hospital, Inc.; and Medical Center of Trinity) agreed to pay $2 million to resolve charges of violating the False Claims Act through billing Medicare for unnecessary lab tests and double billing for fetal testing. The allegations first arose in a whistleblower lawsuit by HCA employee Kelly Oxendine under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of roughly $400,000 from the government’s recovery. DOJ(SC)

Tagged in: Bundling and Unbundling, FCA Federal, Hospital Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

October 19, 2015

Millennium Health (formerly Millennium Laboratories) agreed to pay $256 million to the federal and state governments to resolve charges it billed Medicare for medically unnecessary urine drug and genetic testing. According to the government, Millennium caused physicians to order excessive numbers of urine drug tests, in part through the promotion of “custom profiles,” which instead of being tailored to individual patients were in effect standing orders that caused physicians to order large number of tests without an individualized assessment of each patient’s needs. The government further alleged that Millennium’s provision of free point of care urine drug test cups to physicians — expressly conditioned on the physicians’ agreement to return the urine specimens to Millennium for hundreds of dollars’ worth of additional testing — violated the Stark Law and the Anti-Kickback Statute. The case originated from several whistleblower lawsuits filed under the qui tam provisions of the False Claims Act. Whistleblowers in the underlying cases will receive awards totalling roughly $32 million. DOJ GA , FL, WA

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Lack of Medical Necessity, Whistleblower Case, Whistleblower Rewards,

October 1, 2015

Strata Pathology Laboratory, Inc. (known as StrataDx) agreed to pay $558,793 to resolve allegations it violated the False Claims Act by inducing physicians to refer Medicare and Medicaid patients to Strata by paying kickbacks in the form of sham consulting fees and providing unlawful discounts to physicians. According to the settlement agreement, Strata acknowledged paying consulting fees to two referring physician practices that did not provide consulting services in exchange. Strata also acknowledged entering into “account billing” arrangements with seven referring physician practices that facilitated fee-splitting between the parties. The allegations originated in a whistleblower lawsuit filed by a former Strata employee under the qui tam provisions of the False Claims Act. The whistleblower will receive a yet-to-be-determined whistleblower award from a portion of the government’s recovery. DOJ (MA)

Tagged in: Anti-Kickback and Stark, FCA Federal, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

August 18, 2015

Hovik Simitian, owner and operator of three medical clinics located in Los Angeles, pleaded guilty to submitting more than $4.5 million in fraudulent claims to Medicare. Simitian admitted he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to his clinics, Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic. Simitian also admitted they billed Medicare for lab tests and other services that were not medically necessary or not actually provided and created false documentation reflecting the services had been provided. DOJ

Tagged in: Anti-Kickback and Stark, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Provider Fraud,

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