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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:

Page 24 of 41

February 1, 2019

Ali Jama, co-owner of Alpha Star Health Care Inc., was sentenced to 18 months in prison for health care fraud and tax fraud schemes against Medicare and Medicaid. Jama billed the government for services performed by unqualified individuals with criminal backgrounds who were prohibited from providing direct care. Jama also billed for services provided by untrained home health aides and provided false documents and false records for his taxes to reduce his company’s tax liability from approximately $680,000 to $81,000. Jama has been ordered to forfeit $300,000 and pay $392,000 in restitution to Medicaid. He must also pay the IRS $311,000 in restitution. DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medicare, Tax Fraud,

January 28, 2019

Avanti Hospitals LLC and six of its owners will pay $8.1 million to settle claims that they violated the False Claims Act by submitting, or causing Avanti’s subsidiary, Memorial Hospital of Gardena, to submit false claims to the Medicare and Medicaid programs for medical services referred by a physician who received kickbacks and other improper payments from Gardena and other Avanti affiliates. The settlement partially resolves allegations originally brought in a whistleblower lawsuit filed by Dr. Joshua Luke, the former C.E.O. of Gardena Hospital. DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medicaid, Medicare, Whistleblower Case,

January 22, 2019

Walgreens Co. will pay the U.S. and the State of Wisconsin $3.5 million to settle a case under the False Claims Act alleging that the retail pharmacy routinely dispensed stimulant medications to Wisconsin Medicaid beneficiaries without first verifying that the prescribing physician ordered the medication for medically appropriate treatment, such as treatment for attention deficit disorder. The case was initiated by unidentified whistleblowers, who will receive a share of the settlement to be determined. USAO EDWI

Tagged in: FCA Federal, FCA State, Lack of Medical Necessity, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

January 22, 2019

Walgreens Boots Alliance, Inc. will pay $60 million to settle a False Claims Act case brought by a whistleblower alleging that the retail pharmacy chain knowingly overcharged Medicaid when it charged the healthcare program more than "usual and customary price" for medications that participants in Walgreens "Prescriptions Savings Club" received at a lower price.  Of the settlement, approximately $32 million will be paid to the U.S. and $28 million to the affected states.  Whistleblower Marc D. Baker will receive a share of the total settlement, to be determined at a later date.  USAO SDNY

Tagged in: Drug and DME Pricing, FCA State, Medicaid, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

January 15, 2019

New York has reached a $9 million settlement with Diamond Braces, a chain of dental offices, and its principal Oleg Drut, DDS, for false claims Diamond made to NY's Medicaid program for orthodontic procedures that were performed by personnel who were not certified to perform the work they did as required by NY state law.  NY

Tagged in: Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud,

Sharp HealthCare - Healthcare Fraud/Kickbacks (Undisclosed)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Sharp HealthCare Center for Research, Sharp’s clinical-trial research arm, paid kickbacks to entice prospective trial sponsors to host clinical trials at Sharp.  In November 2019, the company agreed to pay an undisclosed amount to settle the matter.  Our client received a whistleblower award of an undisclosed portion of the government's recovery.  Read more -- CC.

Tagged in: Anti-Kickback and Stark, FCA Federal, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Whistleblower Rewards,

January 11, 2019

 Teva Pharmaceuticals USA Inc. will pay $135 million to the state of Illinois to settle allegations that published fraudulently inflated Average Wholesale Prices (AWPs) for numerous prescription drugs.  Illinois's Medicaid program bases its drug reimbursements for Medicaid beneficiaries on AWPs, and the inflated AWPs caused Illinois to overpay. IL AG

Tagged in: Drug and DME Pricing, Medicaid, Pharma Fraud,

December 18, 2018

Following an earlier settlement of federal claims, Florida has announced that hospital chain Health Management Associates, LLC, will pay $5.5 million to Florida to resolve claims that two HMA hospitals, Charlotte Regional Medical Center and Peace River Medical Center, billed the Florida Medicaid program for services referred by physicians to whom HMA provided remuneration in return for patient referrals.  The unlawful remuneration took the form of free rent, office space, and staff services, as well as direct payments purportedly meant to cover overhead and administrative costs.  FL AG

Tagged in: Anti-Kickback and Stark, FCA State, Healthcare Fraud, Hospital Fraud, Medicaid,

December 14, 2018

Crossroads Hospice of Kansas has agreed to pay $300,000 for violating the Kansas False Claims Act. Under that law, once a healthcare provider is alerted to charges improperly submitted to the state's Medicaid program, it is obligated to refund the reimbursement in a timely manner or risk prosecution. In the case of Crossroads, the provider had failed to refund money paid on behalf of improperly certified beneficiaries. KS AG

Tagged in: FCA State, Home Health and Hospice, Lack of Medical Necessity, Medicaid,

December 13, 2018

Relationship Toward Self-Discovery (RTS), the operator of a residential care facility for developmentally disabled adults, has been ordered to pay $2.79 million in the first ever Medicaid False Claims Act trial in the State of Washington. Initially filed by a former bookkeeper turned whistleblower, the lawsuit alleged that from 2012 to 2015, RTS billed Medicare for 60,328 "sleep hours" spent by overnight employees at its facility. Per state law, a "sleep rate" is required to be paid to overnight employees for every hour spent on call on site; if the employees are called to work, a regular rate is paid instead. Although Medicare reimbursed the company for $928,221, RTS allegedly paid its employees only a fraction of the amount owed to them, and in a single year, the difference between the amount RTS reported to Medicare that it paid and the actual amount it paid totaled as much as $200,000. WA AG

Tagged in: FCA State, Medicaid, Whistleblower Case,

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