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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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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

June 10, 2022

A doctor who allegedly submitted claims to Medicare and Medi-Cal for unperformed procedures, services, and tests, in violation of the California and federal False Claims Acts, has agreed to pay $9.5 million to resolve a civil suit.  The qui tam case by Minas Kochumian’s former medical assistant Elize Oganesyan, and former IT consultant Damon Davies, alleged that claims for treatment of osteopathic issues that were submitted over a six year period were false.  The settlement includes $5.5 million that Kochumian already paid as criminal restitution in a separate case in the Central District.  As part of the civil settlement, Oganesyan and Davies will share a $1.75 million award.  CA AG; USAO EDCA

June 8, 2022

Pharmaceutical manufacturer Dr. Reddy’s Laboratories (DRL) has agreed to pay $12.9 million to the State of Texas to resolve allegations of violating the Texas Medicaid Fraud Prevention Act.  DRL had allegedly reported inflated drug prices to the Texas Medicaid program in order to receive higher reimbursements.  TX AG

June 3, 2022

Rodney L. Yentzer will pay $900,000 for violating the False Claims Act. Through Pain Medicine of York, a group of clinics he controlled, Yentzer caused the submission of false claims for payment to Medicare for urine drug tests that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. He is excluded from participation in all federal health care programs for 22 years. In March of 2022, Yentzer pleaded guilty to Health Care Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the U.S. Department of Health and Human Services between 2016 and 2020. USAO MDPA

June 2, 2022

Middle Georgia Family Rehab (MGFR) has been ordered to pay $9.6 million in damages after a judge for the Middle District of Georgia found the facility had fraudulently billed TRICARE and Medicaid.  In an April order granting partial summary judgment, the Court determined that approximately 800 claims submitted to federal healthcare programs were billed under therapists who were not employed at MGFR at the time of alleged service.  USAO MDGA

June 1, 2022

Behavioral health provider Healthkeeperz, Inc. has agreed to pay $2.1 million to resolve allegations that it falsely billed North Carolina’s Medicaid program for services that were not covered.  The allegations arose from a lawsuit filed by Ginger Hill under the qui tam provisions of the federal False Claims Act and the North Carolina False Claims Act.  USAO WD NC; NC

May 18, 2022

Peter Bolos and Michael Palso, owners of Synergy Pharmacy, were sentenced to 14 years and 33 months in prison, respectively, and each will pay $24.6 million in restitution for defrauding pharmacy benefit managers into authorizing millions of dollars in claims paid to pharmacies controlled by the defendants. Bolos will forfeit an additional $2.5 million. The conspiracy involved cold-calling patients and deceiving them into accepting certain drugs (i.e., pain creams, scar creams, and vitamins) and providing their personal insurance information to receive them. The scheme impacted both private and public insurers, including Medicaid and TRICARE. DOJ, USAO EDTN

May 9, 2022

Prism Behavioral Solutions has agreed to pay $650,000 to resolve allegations of violating the federal and California False Claims Acts by billing California’s Medicaid program for services not provided to autistic children and young adults.  The whistleblower in this case, Diana Mason, is a behavioral analyst employed by Prism, and will receive a $170,000 share of the settlement.  USAO SDCA; CA AG
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