Medicaid

November 22, 2017

Thaddeus M.S. Bereday, the former general counsel of WellCare Health Plans Inc., a company that operates health maintenance organizations in several states, was sentenced to six months in prison for his role in a $35 million health care fraud scheme.  Specifically, Bereday and others were charged with submitting inflated expenditure information in the WellCare's annual reports to Florida Medicaid in order to reduce the WellCare HMOs’ contractual payback obligations for behavioral health care services.  DOJ

October 24, 2017

A federal judge awarded the government roughly $2 million in a verdict against Maryland-based home health care company Dynamic Visions, Inc. for violating the False Claims Act because its employees repeatedly and routinely falsified records to obtain funds from Medicaid.  Specifically, a government investigation found many of the company's patient files did not contain physician authorizations, called “plans of care,” as required under applicable regulations; contained plans of care that were not signed by physicians or other qualified health care workers; or contained forged signatures in order to cover up the lack of a physician’s authorization. DOJ (DDC)

September 5, 2017

National dental chain Dental Dreams, LLC agreed to pay $1.375 million to resolve allegations it improperly billed the Massachusetts Medicaid program for unnecessary and unjustifiable dental procedures.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dental Dreams former employee.  The whistleblower will receive an award from the proceeds of the government's recovery.  DOJ (DMA)

September 1, 2017

New Mexico-based Christus St. Vincent Regional Medical Center and its partner Texas-based Christus Health agreed to pay $12.24 million to resolve allegations they violated the False Claims Act by making illegal donations to county governments which were used to fund the state share of Medicaid payments to the hospital.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Los Alamos County, New Mexico Indigent Healthcare Administrator.  The whistleblower will receive an award of $2.25 million from the proceeds of the government's recovery. DOJ

November 15th, 2017

New York announced the sentencings of Kenneth Cohn, Sharon Cohn, and Yellow Medi-Van and Taxi, Inc., for stealing hundreds of thousands of dollars in Medicaid funds and knowingly operating transportation services without Worker’s Compensation insurance. At sentencing in Broome County Court, the Cohns forfeited and released $455,604 currently being withheld by the New York State Department of Health, to the Attorney General’s Medicaid Fraud Control Unit. Each defendant also agreed to pay $50,000 in restitution, for a total of $100,000. Kenneth Cohn was sentenced to five years’ probation, and Sharon Cohn was sentenced to one year conditional discharge. Yellow Medi-Van and Taxi, Inc. was sentenced to three years conditional discharge. NY

October 16, 2017

Louisiana announced the arrests of three New Orleans women as a result of an investigation exposing over $2 million in Medicaid Fraud. Lanice Stamps, 44 of New Orleans and owner of A New Direction Support Services, was arrested on 10 counts of Medicaid fraud for allegedly providing false and fraudulent claims for behavioral health services not rendered. Many recipients were fraudulently diagnosed as moderately mentally retarded or severely autistic so that the claims submitted could be billed at a higher level and they had never received counseling services. LA

August 18, 2017

Illinois and other states announced a $465 million settlement between the federal government and states with Mylan Inc. and its wholly-owned subsidiary, Mylan Specialty L.P. (Mylan), to resolve allegations that Mylan knowingly underpaid rebates owed to the Medicaid program for EpiPen® and EpiPen Jr.® (EpiPen) dispensed to Medicaid beneficiaries. The settlement resolves allegations that from July 29, 2010 to March 31, 2017, Mylan submitted false statements to the Centers for Medicare and Medicaid Services (CMS) that incorrectly classified EpiPens under terms defined in the Rebate Statute and Rebate Agreement. Mylan also failed to report a "Best Price" to CMS for EpiPens, as directed by the same statute. As a result, Mylan submitted false statements related to EpiPens to CMS and the states for Medicaid rebate purposes and underpaid EpiPen rebates to the state Medicaid programs. IL, IA