Lack of Medical Necessity

June 29, 2015

New York announced a settlement with pharmacy Trinity Homecare LLC that returns $2.5 million to the state’s Medicaid program. A whistleblower filed a lawsuit in 2009 alleging that Trinity pushed infusion drugs, which are prescribed to manage symptoms, to hemophilia patients and presented claims to Medicaid for unneeded or excessive quantity of these drugs. The whistleblower alleged improper billing for drug deliveries, including ones that patients refused to accept and excess shipments. In at least one instance, these expensive drugs were allegedly left outside a patient’s home without signature by the patient. NY

April 16, 2015

Georgia doctor Zheng Xiang Wang and the Wang Eye Clinic, P.C. agreed to pay $790,000 to settle allegations they billed Georgia Medicaid for medically unnecessary ophthalmology procedures. GA

Rose Cancer Center - Healthcare Fraud ($5.7 million)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Mississippi-based Rose Cancer Center used unqualified technicians performing bone marrow biopsies, diluted chemotherapy drugs, and falsified patient records to conceal the clinic’s fraudulent Medicare billings.  The physician who owned and ran the practice plead guilty to various Medicare fraud violations, forfeited $5.7 million, and was sentenced to 20 years in prison.  In August 2014, our client (along with three other whistleblowers) received a whistleblower award of $525,000 from the government's recovery.  Read more -- Clarion Ledger, CC.

April 23, 2014

Amedisys home health companies agreed to pay $150M resolve allegations they violated the False Claims Act by allegedly billing Medicare for nursing and therapy services not medically necessary or provided to patients who were not homebound, and by otherwise misrepresenting patients’ conditions to increase its Medicare payments. The allegations were first raised in several qui tam lawsuit filed by former Amedisys employees under the whistleblower provisions of the False Claims Act. DOJ

January 5, 2014

New York Attorney General Eric T. Schneiderman announced that Apple Transportation of New York, Inc. will pay $300,000 to settle claims it overbilled Medicaid for transportation services. As part of a settlement agreement, Apple Transportation admitted that between January 1, 2004 and October 30, 2008, it frequently billed Medicaid for ambulette services even though no personal assistance was provided to Medicaid recipients. As a result, Apple was paid by Medicaid for ambulette services at rates that were higher than the applicable livery rates. NY

August 19, 2013

Shands Teaching Hospital & Clinics agreed to pay $26M to settle allegations that six of its health care facilities submitted false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ