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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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August 11, 2020

The former owner of Texas-based All Smiles Dental Center has been ordered to pay $16.5 million to the State of Texas for improperly billing Texas Medicaid for tens of millions of dollars in services that he did not deliver, including services allegedly performed while he was vacationing abroad.  In total, Dr. Richard Malouf was found to have committed 1,842 unlawful acts under the Texas Medicaid Fraud Prevention Act.  AG TX

Catch of the Week: Indivior Agrees to Pay $600 Million to Settle Opioid Fraud Case

Posted  07/31/20
pill container spilled over with pills in the form of a dollar sign
The latest in our Catch of the Week series features Indivior Solutions’ (“Indivior”) agreement to pay $600 million to resolve criminal and civil liability associated with the marketing of the opioid-addiction-treatment drug Suboxone. This is in addition to the $1.4 billion resolution with Indivior’s former parent, Reckitt Benckiser Group PLC (“RB Group”) that was previously announced in 2019. Suboxone is a...

July 30, 2020

Computer Sciences Corporation (CSC), now known as DXC Technology, and New York City have agreed to pay approximately $2.8 million to resolve allegations of violating the federal and New York State False Claims Acts in connection with New York City’s Early Intervention Program (EIP), which provides speech and physical therapy services for infants and toddlers with possible developmental disabilities.  According to a qui tam lawsuit, while retained by the City to process and submit its EIP claims to various insurers, CSC allegedly received permission from the City to categorize claims submitted to private insurers as “denied” if no response was received within 90 days.  CSC then resubmitted those claims to Medicaid using an improper code, causing Medicaid to make payments it would not have otherwise.  For revealing the misconduct, the unnamed whistleblower in this case will receive $416,250.  AG NY; USAO SDNY

July 23, 2020

Progenity, Inc., f/k/a Ascendant MDx, Inc., has agreed to pay a total of $49 million to resolve allegations that the California-based clinical laboratory submitted false claims to Medicaid, the VA, TRICARE, and the Federal Employees Health Benefits Program (FEHBP) through different fraudulent schemes.  First, from 2012 to 2016, Progenity allegedly billed the programs for non-reimbursable prenatal tests using a reimbursable billing code.  Second, in claims originally brought by a whistleblower under the False Claims Act, the company was alleged to violate the Anti-Kickback Statue by providing improper incentives to physicians—including paying above fair market value for blood specimen “draw fees”, providing tens of thousands of dollars in free food and alcohol, and routinely reducing or waiving co-insurance or deductibles—in order to induce physicians to order their tests.  Approximately $35.9 million of the settlement proceeds will go toward resolving federal claims, with the remaining $13.1 million paid to different states.  AG NC; USAO SDCA; USAO SDNY

July 22, 2020

Tony Garrett Taylor has been sentenced to 8 years in prison and ordered to pay over $6 million to the North Carolina Medicaid program and over $1 million to the IRS after pleading guilty to committing healthcare fraud and tax evasion.  Along with his brother, Jerry Lewis Taylor, the defendant conspired to use outpatient behavioral health services companies owned and operated by the brothers to submit false claims to Medicaid for services that were either never provided or misrepresented.  Jerry Lewis Taylor has also pleaded guilty and is currently awaiting sentencing.  AG NC

July 21, 2020

The Montachusett Regional Transit Authority (MART), a quasi-public transportation authority that brokers medical transportation, will pay $300,000 to resolve allegations that it improperly caused false claims to be submitted to MassHealth, the Massachusetts state Medicaid program. MART allegedly did not have appropriate procedures in place to verify that its transportation subcontractors had actually provided rides as they claimed, and MART billed MassHealth for thousands of rides that were not, in fact, provided. MA; USAO MA

July 13, 2020

The owner and operator of a skilled nursing facility has agreed to pay $1 million to settle allegations of submitting false claims to Medi-Cal in violation of the California False Claims Act.  According to the Attorney General, Legacy Post-Acute Rehabilitation Center (Legacy) failed to provide the minimum number of nursing hours required for the level of care that it billed for.  AG CA

July 10, 2020

Universal Health Services, Inc. and UHS of Delaware, Inc. (collectively, UHS), and a Georgia-based UHS facility, Turning Point Care Center, LLC, have agreed to pay a combined $122 million to settle 18 qui tam cases pending in four jurisdictions.  In violation of the False Claims Act, UHS allegedly billed federal healthcare programs—including Medicare, Medicaid, TRICARE, the Department of Veteran Affairs, and the Federal Employee Health Benefit programs—for medically unnecessary inpatient behavioral health services, failed to provide adequate or appropriate services, and paid illegal inducements to beneficiaries of those programs.  UHS will pay over $88 million to the federal government and nearly $29 million to individual states, for a combined penalty of $117 million, with a relator share of about $15.8 million.  Turning Point will pay $5 million to the federal government and the State of Georgia; the whistleblower in that case will receive $861,853.64.  USAO MDFL; USAO NDGA; USAO EDPA; AG FL; AG MI; AG NC; AG VA

Oklahoma City Hospital, Management Company, And Physician Group to Pay $72.3 Million To Settle Kickback and Stark Allegations

Posted  07/10/20
Anti-Kickback Stark Law Whistleblower Examples
Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM), a specialty hospital affiliated with Tenet Healthcare in Oklahoma City, Oklahoma, its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), Southwest Orthopaedic Specialists, PLLC (SOS), an Oklahoma City-based physician group, and two SOS physicians, will pay $72.3 million to resolve kickback allegations...

July 8, 2020

A Florida-based nonprofit that provides hospice care, palliative care, and other services to the elderly, has agreed to pay $3.2 million to resolve its liability under the False Claims Act.  According to former Director of Hospice Care, Margaret Peters, Hope Hospice knowingly submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary but highly reimbursed general inpatient (GIP) hospice services over a five year period.  For blowing the whistle on the alleged fraud, Peters will receive a 19% share of the settlement.  USAO MDFL
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