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Medicaid

This archive displays posts tagged as relevant to Medicaid and fraud in the Medicaid program. You may also be interested in our pages:

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September 26, 2022

Biogen Inc. has agreed to pay $900 million to resolve allegations by former employee Michael Bawduniak that the pharmaceutical company paid illegal kickbacks to physicians in order to induce prescriptions of their multiple sclerosis drugs, causing false claims to be submitted to Medicare and Medicaid.  According to Bawduniak, over a five-year period, Biogen paid kickbacks in the form of speaker honoraria, training fees, consulting fees, and free meals.  The vast majority of the settlement proceeds (over $840 million) will go to the federal government, while the remainder will be divided among 15 states.  USAO MA

September 9, 2022

Daniel Pintado Cazola, the true owner of durable medical equipment company Myers Professional Services, has been sentenced to over 7 years in prison for defrauding Medicare and Medicaid and going to great extents to conceal his connection to the crimes.  Pintado Cazola admitted that he purchased lists of Medicare beneficiaries and directed employees to submit over $2.3 million in fraudulent claims to Medicare and Medicaid for durable medical equipment that was not medically necessary, not prescribed by a doctor, and not supplied to a beneficiary.  USAO SDFL

August 24, 2022

Centene will pay Washington State $19 million to resolve allegations that the company overcharged the state for pharmacy benefit management services.  The state alleged that Centene failed to pass on discounts it received to the state Medicaid program, and inflated dispensing fees.  WA

August 23, 2022

Essilor International, Essilor of America, Inc., Essilor Laboratories of America, Inc., and Essilor Instruments USA—which manufactures, markets, and distributes optical lenses and equipment to produce optical lenses—have agreed to pay $16.4 million to resolve allegations of defrauding Medicare and Medicaid.  In two separate qui tam suits, former sales managers Laura Thompson and Lisa Brez, and Christie Rudolph alleged that Essilor violated the Anti-Kickback Statute and False Claims Act by paying illegal kickbacks to optometrists and opthalmologists to induce purchases of their products for patients, including patients covered by Medicare and Medicaid.  USAO EDPA; USAO NDTX

August 18, 2022

The organized healthcare system for Ventura County, as well as three healthcare providers, have agreed to pay a combined total of $70.7 million to resolve allegations of violating the California and federal False Claims Acts in connection with Medi-Cal’s Adult Expansion program, which extended coverage to previously uninsured adults without dependents.  Gold Coast Health Plan, Dignity Health, Clinicas del Camino Real, Inc., and Ventura County (the owner and operator of Ventura County Medical Center) allegedly submitted, or caused to be submitted, bills for unallowed expenses, bills for “Additional Services” that were duplicative of services already required, and bills with pre-determined costs that weren’t reflective of fair market value.  CA AG; USAO CDCA

July 27, 2022

ca Glenn Pair and Markuetric Stringfellow will spend 70 and 78 months in prison, respectively, and pay over $5 million each in restitution for defrauding three States’ Medicaid programs of more than $5 million, and for receiving $1.8 million in kickbacks from participating laboratories. The two owned and operated Do-It-4-The Hood Corporation in North Carolina and later expanded to Georgia. They targeted Medicare-eligible children, enrolled them in their programs, and required them to submit urine specimens for drug testing. Drug testing was in turn billed to Medicaid by complicit laboratories, who then paid kickbacks after receiving Medicaid reimbursement. Through their Wrights Care Services LLC franchise in South Carolina, the two filed fraudulent Medicaid claims for mental health counseling, going so far as to host a “note party,” upon learning of a Medicare audit of Wrights Care, to cover up their scheme by creating false billing records to substantiate their fraudulent Medicaid claims. USAO WDNC, USAO SC

July 26, 2022

Dr. Don Flanagan, D.D.S. and his companies Dental Center, Inc. and Dental Center, P.C. d/b/a Cloudland Dental, will pay $1.5 million for submitting or causing to be submitted claims for payment by falsely identifying Dr. Flanagan as the credentialed physician rendering services. TennCare requires dentists to be credentialed as part of the approval process for billing, yet, from January 2015 through February 2019, services were rendered by uncredentialed dentists, which is a violation of the Tennessee Medicaid False Claims Act. EDTN USAO

July 26, 2022

Mallinckrodt ARD, LLC f/k/a Questcor Pharmaceuticals, Inc. will pay over $233 million over a 7-year period to settle False Claims Act violations, which occurred from January 2013 through June 2020. During this time, Mallinckrodt knowingly underpaid Medicaid rebates on its H.P. Acthar Gel. The practice was exposed by a whistleblower lawsuit originally filed in Massachusetts. Mallinckrodt paid rebates for Achtar in 2013 as if it was a “new drug” rather than one that was introduced to the market in 1952. NJ OAG

July 22, 2022

Medical device manufacturer Biotronik Inc. has agreed to pay nearly $13 million to resolve allegations of paying kickbacks to physicians in order to induce use of their implantable cardiac devices, and causing false claims to be submitted to Medicare and Medicaid.  The alleged violations of the Anti-Kickback Statute and False Claims Act were brought to light in a qui tam suit by Jeffrey Bell and Andrew Schmid, both former sales representatives for Biotronik, who as part of the settlement will receive a $2.1 million relator’s share.  USAO CDCA

June 13, 2022

Centene Corporation has agreed to pay $13.7 million to the State of New Mexico, after an investigation by the Attorney General’s Office found the company layered fees and failed to pass discounts onto the state’s Medicaid program, in violation of Medicaid rules and the New Mexico Medicaid False Claims Act.  NM AG
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