Medicaid
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November 5, 2019
A home health agency that allegedly defrauded Medicare and Louisiana’s Medicaid program has agreed to pay $2.5 million to settle claims arising from a qui tam suit. Defendants Health Care Options, Inc., Health Care Options of Lafayette, Inc., Home Care Options Houston, Inc., and Howard Austin, II allegedly submitted reimbursement claims involving non-face-to-face encounters, as required by program rules. USAO MDLAOctober 28, 2019
The State of Illinois has reached a settlement with more than a dozen drug manufacturers alleged to have published inflated "average wholesale prices" for drugs whose purchase was reimbursed by Illinois's Medicaid program at prices based on those false AWPs. The settlement for $242 million includes Abbott Laboratories, Inc.; Aventis Pharmaceuticals Inc.; Aventis Behring LLC, n/k/a ZLB Behring; B. Braun Medical Inc.; Forest Laboratories, Inc.; GlaxoSmithKline LLC; Johnson & Johnson, Inc.; Janssen Pharmaceutical Products, LP; McNeil-PPC, Inc.; Ortho Biotech Products, LP; Ortho-McNeil Pharmaceutical, Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Pharmacia Corporation; and TAP Pharmaceutical Products, Inc. In total, Illinois has settled inflated AWP claims against more than four dozen manufacturers (see, e.g., January 2019 settlement with TEVA Pharmaceuticals), recovering $678 million in total. IL AGOctober 28, 2019
Sanford Health, Sanford Medical Center, and Sanford Clinic have agreed to pay $20.25 million and enter into a Corporate Integrity Agreement in order to resolve alleged violations of the Anti-Kickback Statute and False Claims Act. Despite warnings by several physicians that a top neurosurgeon was illegally profiting off his use of implantable medical devices as well as performing medically unnecessary surgeries involving the devices, Sanford did nothing to stop the offender, allowing Medicare and Medicaid to continue being defrauded. The allegations were raised by Sanford surgeons Drs. Carl Dustin Bechtold and Bryan Wellman, who will share in a $3.4 million cut of the settlement proceeds. DOJ; USAO SDOctober 15, 2019
Otolaryngologist Dr. Tracey Wellendorf has agreed to pay $1 million to resolve allegations of violating the False Claims Act in at least 115 procedures billed to Iowa Medicaid. The alleged misconduct occurred between 2014 and 2015 and involved endoscopic sinus surgeries that were either medically unnecessary or incorrectly coded. USAO NDIAOctober 4, 2019
Southern California-based Retina Institute of California Medical Group (RIC), its former CEO, and several of its physicians have agreed to pay the State of California and United States $6.65 million to settle alleged violations of state and federal False Claims Acts. According to former administrators Bobbette Smith and Susan Rogers, between 2006 and 2017, the ophthalmology group improperly billed Medicare and Medicaid for unnecessary and unperformed eye exams, upcoded simple exams using codes normally reserved for emergency conditions, and waived mandatory co-payments and deductibles to induce patient referrals. Smith and Rogers will receive a relator’s share, which remains to be determined. USAO CDCAOctober 3, 2019
Counselor Valerie Williams and her business, Circle of Life Transition Center, LLC, will pay $45,500 to resolve claims that they submitted false claims to the Connecticut Medicaid program, representing that services had been provided by Williams when, in fact, those services had been provided by unlicensed individuals. USAO CTSeptember 25, 2019
Mobile diagnostic service provider Trident USA Health Services LLC has agreed to pay $8.5 million to settle two whistleblower cases alleging violations of the False Claims Act. Trident’s CIO, Ravi Srivastava, and a regional sales manager, Peter Goldman, had each filed their own qui tam suits alleging Trident had been engaged in a kickback scheme with skilled nursing facilities between 2006 and 2019. For their efforts, Srivastava will receive $2 million and Goldman will receive $106,250 of the government’s recovery. USAO EDPACatch of the Week: Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud
Posted 09/18/19
Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ
Posted 09/13/19
