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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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Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

Posted  10/22/21
Person wearing lab coat in laboratory
Clinical laboratory MD Labs Inc., and co-founders and owners, Denis Grizelj and Matthew Rutledge, settled charges the lab falsely billed Medicare, Medicaid, and other federal payors for pricey and unnecessary urine drug tests. Over a four-year period, the lab regularly ran two different drug tests at once and then sent results from both tests to the ordering healthcare physician simultaneously, according to the...

Catch of the Week: Private Equity Firm and Former Executives of a Mental Health Center Reach $25 Million Medicaid Settlement

Posted  10/15/21
dollar bill with Medicaid text ripped through
In recent years there has been a proliferation of private equity firms taking oversight of healthcare entities. These private equity firms have increased their exposure to False Claims Act liability by playing active roles in the operation of healthcare entities, and multiple settlements have been reached over the last two years (on kickbacks and promotion of unapproved use of drug-device systems on pediatric...

October 14, 2021

Owners and executives of Massachusetts mental health provider South Bay Mental Health Center, Inc. have agreed to pay $25 million to resolve claims that they caused the submission of false claims to the state’s Medicaid program, MassHealth, by billing for services provided by unlicensed, unqualified, and improperly supervised staff members in violation of MassHealth regulations. Defendants  H.I.G. Growth Partners, LLC and H.I.G. Capital, LLC will pay $19.95 million and defendants Peter J. Scanlon and Kevin P. Sheehan, who held executive and board positions at relevant entities, will pay $5.05 million.  The case was initiated by the filing of a whistleblower complaint under the Massachusetts False Claims Act.  SBMHC previously agreed to pay $4 million to resolve related charges.  Mass

September 15, 2021

A cardiologist in Florida who allegedly billed Medicare and Medicaid for medically unnecessary procedures has agreed to pay $6.75 million to resolve claims under the False Claims Act.  Between 2013 and 2019, Dr. Ashish Pal allegedly made misrepresentations in patient medical records to justify ablations and vein stent procedures that were not reimbursable under program rules.  Additionally, some of the procedures were later found to have been performed primarily by unqualified ultrasound technicians.  As part of the settlement, Pal and Interventional Cardiology & Vascular Consultants, PLC, will enter in a multiyear integrity agreement and comply with training and reporting requirements, as well as a quarterly claims review by an independent organization.  USAO MDFL

DOJ Reasserts the Proper Role for Agency Guidance in Fraud Cases

Posted  09/3/21
Department of Justice Logo
The Justice Department has quietly rescinded a Trump administration policy that was needlessly undermining the role of government agency guidance.  On July 1, 2021, Attorney General Merrick Garland issued a memorandum revoking what is known as the Brand Memo.  In her memo, Former Associate Attorney General Rachel Brand had set out a position that defense attorneys scrambled to use to argue for leniency or...

August 25, 2021

A California-based provider of home respiratory services and durable medical equipment has agreed to pay $3.3 million to the United States and States of California and Nevada to settle allegations of defrauding Medicare and Medicaid.  The claims against SuperCare Health, Inc. were brought in a 2018 qui tam suit by respiratory therapist Benjamin Martinez, who alleged that the provider billed for non-invasive ventilators (NIVs) that were no longer needed or being used by patients.  CA AG; USAO CDCA

Court says that fraudsters who violate rules they later claim are unclear may not violate the False Claims Act

Posted  08/19/21
Red and yellow pills scattered on hundred dollar bills
Last week, the Seventh Circuit Court of Appeals, the federal appellate court for Illinois, Indiana, and Wisconsin decided U.S. ex rel. Yarberry v. Supervalu, an important decision that may lead more unscrupulous government contractors to help themselves to public funds to which they are not entitled.  Unless the Supreme Court or Congress steps in to correct the Seventh Circuit’s errors, the government may have...

August 17, 2021

Bristol Myers Squibb (BMS) has agreed to pay $75 million to a resolve a whistleblower’s allegations that it underpaid drug rebates owed to state Medicaid programs nationwide.  In order to ensure states pay competitive prices, federal law requires pharmaceutical companies to return a portion of payments from state Medicaid programs, calculated based on the average price paid by drug wholesalers.  The misconduct involved BMS underreporting their drugs’ Average Manufacturer’s Price by treating wholesaler fees as discounts, thus decreasing the amount it supposedly owed to the healthcare programs.  CA AG; NJ AG

July 23, 2021

Alabama non-profit SpectraCare Health Systems, Inc., which provides services including developmental disability services, intermediate care medical services, and behavioral health services, agreed to pay $1 million to resolve claims first brought in a whistleblower action alleging that the provider improperly billed Alabama Medicaid and failed to return overpayments to the Alabama Medicaid Agency.  The defendant was alleged to have submitted false claims including claims without correct and complete documentation, and duplicate claims, and to have knowingly retained payments it received to which it was not entitled.  The settlement will be split between the federal government and the Alabama Medicaid Agency, with the whistleblower receiving 19% of the federal recovery.  USAO MD AL

July 22, 2021

Medical laboratory Bluewater Toxicology, LLC, agreed to pay $1.2 million following its self-report of overbilling for urine drug testing services.  In billing Medicare, Kentucky Medicaid, Indiana Medicaid, TRICARE, and CHAMPVA, Bluewater was alleged to have submitted false claims that misrepresented the number of drugs tested in definitive urine drug tests, that lacked sufficient documentation, or that were for specimen validity testing that is not separately billable to Medicare.  USAO ED KY
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