Medicaid Archives - Page 17 of 41

Opioid Executive Sentenced to Over Five Years in Prison for Role in Healthcare Fraud Scheme

Posted 01/31/20

Insys Therapeutics, an opioid manufacturer whose main product is Subsys, a spray from of fentanyl that is 100 times stronger than morphine and cost tens of thousands a month, is in the news again. The company and its former CEO, John Kapoor, have been facing a mountain of legal issues in the past three years. Last week, in a decision that most of our readers agree with, Kapoor was sentenced to 66 months in prison.

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicaid, Medicare, SEC Whistleblower Reward Program, Whistleblower Case, Whistleblower Rewards,

Top Ten State Healthcare and Financial Fraud Recoveries of 2019

Posted 01/30/20

Here at Constantine Cannon, our attorneys represent whistleblowers reporting a wide variety of healthcare fraud and financial fraud, including government contract fraud, unlawful kickbacks, tax evasion, and more. While such wrongful conduct often violates federal laws, state governments are also important enforcement authorities. For whistleblowers, state enforcement can offer additional opportunities. New York,...

Tagged in: Correctional Services Fraud, Drug and DME Pricing, FCA State, Financial and Investment Fraud, Government Procurement Fraud, Healthcare Fraud, Medicaid, Off-Label and Unapproved Use, Pharma Fraud, Top 10,

Top Ten Healthcare Fraud Recoveries of 2019

Posted 01/24/20

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

January 16, 2020

Udaya Shetty, a psychiatrist in Virginia, was sentenced to over two years in prison and has agreed to pay over $1 million to the United States and the Commonwealth of Virginia to resolve allegations of submitting false claims to Medicare, Medicaid, and TRICARE. Shetty was accused of billing for services that average about 40-60 minutes long, despite quadruple booking patients and only seeing them for about 5-10 minutes each. The scheme began at his own practice, Behavioral & Neuropsychiatric Group, in 2013, and continued at a new practice, Quietly Radiant Psychiatric Services, in 2017. As a result of his actions, government health programs were defrauded of more than $450,000. USAO EDVA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs,

January 15, 2020

ResMed Corp. has agreed to pay $37.5 million to resolve five whistleblower-brought lawsuits alleging that the durable medical equipment (DME) manufacturer paid illegal kickbacks to suppliers, sleep labs, and other health providers, in violation of the Anti-Kickback Statute and False Claims Act. $6.2 million of the settlement will be split amongst the whistleblowers, who had revealed that ResMed improperly provided or helped provide free or below cost call center services, patient outreach services, medical equipment and installation, and interest-free loans, in exchange for business. DOJ; USAO EDNY; USAO NC; USAO NDIA; USAO SC; USAO SDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

January 6, 2020

A now defunct behavioral health clinic, Tree of Life, Inc., and its owners and operators, Ada and Victor Vidal, have agreed to pay $1.65 million to settle a whistleblower's claims that they violated the False Claims Act and Anti-Kickback Statute in claims to Pennsylvania's Medicaid program. According to Erika Desjardins, the former Clinical Director, Tree of Life billed for therapy sessions where either the patient or therapist could not possibly have attended (in some cases due to a patient’s hospitalization or death), as well as therapy sessions provided by unqualified individuals. To facilitate the fraud scheme, it created fake records, including forged signatures, and improperly paid a social worker for patient referrals. As part of the settlement, the Vidals have been excluded from future participation in federal healthcare programs, and Desjardins, who had been fired for reporting internally, will receive $330,000 as their share of the recovery. USAO EDPA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 17, 2019

Miracle Home Care, Inc. and its owner, Shashicka Tyre-Hill, have together been ordered to pay more than $10 million following judgment in an action under the False Claims Act finding that defendants defrauded Georgia’s Medicaid program. In a civil complaint filed in July 2018, the federal government and State of Georgia alleged that Miracle Home Care submitted thousands of fraudulent reimbursement claims for medically unnecessary transportation and health services. USAO SDGA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicaid, Medical Billing Fraud,

December 13, 2019

In the Attorney General’s first-ever trial under the Connecticut False Claims Act, Dr. Aram Agadjanian, a dentist in Connecticut, has been ordered to pay the State of Connecticut more than $1.7 million for defrauding the state's Medicaid program from 2014 to 2015. Dr. Agadjanian, also known as Aram Yuri Agadzanov, submitted claims to Medicaid for dental work that was never provided to Medicaid patients, even going so far as to create fake records to back up the claims. CT AG

Tagged in: Healthcare Fraud, Medicaid,

December 3, 2019

In the second settlement to come out of a federal investigation into the generic pharmaceutical industry, Rising Pharmaceuticals Inc. has agreed to pay over $4 million to settle civil and criminal charges stemming from violations of the False Claims Act and Anti-Kickback Statute. In the criminal case, Rising allegedly teamed up with a competing generic drug manufacturer to fix prices and divide up the market for a hypertension drug, Benazepril HCTZ, while in the civil case, the company allegedly paid and received illegal remuneration through similar arrangements with another generic drug manufacturer. Under the newly signed deferred prosecution agreement, Rising has agreed to cooperate fully with the ongoing investigation. DOJ; USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Pharma Fraud, Price Fixing, Pricing Fraud,

November 22, 2019

Ave Maria Family Practice PLLC and its principal, Dr. Dorothy Agbafe-Mosley, have agreed to pay $1.25 million to the State of North Carolina to resolve claims that they falsely billed the state's Medicaid program for addiction treatment services allegedly provided to Medicaid beneficiaries. In fact, the services were not medically necessary, had no supporting clinical documentation, or were otherwise performed in violation of Medicaid policy. NC

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Provider Fraud,

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