Lack of Medical Necessity

January 18, 2018

Detroit-area doctor Gerald Daneshvar was sentenced to 24 months in prison for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulted in inappropriately high payments. DOJ

January 10, 2018

Florida pharmacy Healthy Meds Pharmacy Corp. agreed to pay $350,000 to settle allegations under the False Claims Act for filling prescriptions in violation of TRICARE’s policy on telemedicine.  According to the government, Healthy Meds engaged in unsolicited calls to TRICARE beneficiaries, provided medically unnecessary compound medications to beneficiaries, and knowingly filled prescriptions from doctors who did not meet or properly consult with TRICARE beneficiaries. DOJ (SDFL)

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)

December 28, 2017

Maryland physician Jui Chih Hsu agreed to pay roughly $1.2 million to settle claims of violating the False Claim Act by submitting false claims to Medicare for medically unnecessary vitamin injections and evaluation and management services that were not documented.  DOJ (DMD)

December 21, 2017

Florida-based Haven Hospice agreed to pay roughly $5 million to resolve allegations that Haven violated the False Claims Act by knowingly billing the government for medically unnecessary and undocumented hospice services. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Haven employee Dr. John Simons. Dr. Simons will receive a whistleblower award of roughly $900,000 from the proceeds of the government's recovery. DOJ (MDFL)

December 19, 2017

Two physician groups, EmCare Inc. and Physician’s Alliance Ltd, agreed to pay more than $33 million to settle charges of violating the False Claims Act and Anti-Kickback Statute for allegedly receiving kickbacks in exchange for patient referrals to hospitals owned by the now-defunct Health Management Associates. Dallas-based EmCare agreed to pay $29.6 million to resolve allegations it received remuneration from HMA to recommend patients be admitted to HMA hospitals on an inpatient basis when the patients should have been treated on an outpatient basis. In a separate settlement, Pennsylvania-based Physician's Alliance agreed to pay $4 million for allegedly accepting illegal remuneration from HMA to refer patients to two HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center. The allegations originated in whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Drs. Thomas Mason and Stephen Folstad brought the qui tam suit against EmCare and will receive a whistleblower award of roughly $6.2 million from the proceeds of the government's recovery. Former HMA hospital executives George E. Miller and Michael J. Metts brought the qui tam suit against Physician's Alliance and will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ

December 1, 2017

Dr. Arthur S. Portnow, the owner and operator of Arthur S. Portnow, P.A. (d/b/a Apple Medical and Cardiovascular Group) agreed to pay $1.95 million to resolve allegations that he and his practice violated the False Claims Act by knowingly seeking reimbursement for medically unnecessary ultrasound tests that were performed on Medicare beneficiaries.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act Kathleen Siwicki, a former employee of Dr. Portnow’s practice.  She will receive a whistleblower award of roughly $350,000 from the proceeds of the government's recovery.  DOJ (MDFL)