Medicaid

July 7, 2017

Wal-Mart Stores Inc. agreed to pay $1.65 million to resolve allegations it violated the False Claims Act by submitting pharmacy claims to California’s Medi‑Cal program not supported by applicable diagnosis and documentation requirements.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a Wal-Mart pharmacist.  The whistleblower will receive a whistleblower award of roughly $264,000 from the proceeds of the government's recovery.  DOJ (EDCA)

June 30, 2017

Dawn Bentley, a Detroit-area medical biller, was sentenced to 50 months in prison and to pay roughly $3.3 million for her role in a $7.3 million Medicare and Medicaid fraud scheme involving medical services that were billed to Medicare and Medicaid but not rendered as billed.  DOJ

August 4, 2017

Georgia announced a civil settlement with The Medical Center of Central Georgia, Inc., more commonly known as The Medical Center, Navicent Health (Navicent). Navicent agreed to pay to the United States and the State of Georgia $2,549,742 to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary. Additionally, Navicent’s current Corporate Integrity Agreement (CIA) will be heightened and extended to cover the newly resolved conduct. A CIA is an agreement between a private provider of services and the United States whereby the provider, at its own expense, institutes and maintains a program, overseen by the OIG with reviews by an independent review organization, to insure compliance with the laws and regulations regarding participation in federally funded programs. GA

July 17, 2017

New York-based home health care company Visiting Nurse Service of New York and its subsidiaries VNS Choice and VNS Choice Community Care agreed to pay roughly $4.4 million to settle charges of violating the False Claims Act by improperly collecting monthly Medicaid payments for 365 Medicaid beneficiaries whom VNS Choice failed to timely disenroll from the VNS Choice Managed Long-Term Care Plan.  Once VNS disenrolled the members, it did not repay Medicaid for the funds it had improperly received. By knowingly retaining overpayments for many of these members for more than 60 days, the VNS entities violated both the federal and state false claim acts. As a result, New York State will receive $2.63 million as part of the settlement agreement.The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by an undisclosed whistleblower.  The whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)  NY

July 13, 2017

New York announced the convictions of Kenneth Cohn and Sharon Cohn and Yellow Medi-Van and Taxi, Inc., for Medicaid fraud and related charges. Broome County residents Kenneth Cohn and Sharon Cohn owned and operated Yellow Medi-Van and Taxi, Inc., a transportation company providing transportation to medical appointments for Medicaid recipients in Broome County. During the period June 2, 2012, to January 30, 2014, the defendants knowingly operated Yellow Medi-Van and Taxi in violation of Broome County transportation regulations and the New York State Workers’ Compensation Act, by failing to have Worker’s Compensation insurance. The defendants agreed to forfeit and release $455,604.39 of the funds received from Medicaid to the New York State Medicaid Fraud Control Unit. They also entered into a settlement agreement for an additional $50,000.00. NY

June 7, 2017

New York announced that Kester Atumonyogo, of Valley Stream, NY, and his company Monack Medical Supply, Inc. were arraigned on an indictment charging Atumonyogo and Monack with billing Medicaid and Healthfirst, a Medicaid managed care organization, for an expensive nutritional formula while supplying patients with a lower-priced substitute and stealing over $1 million in the process. Atumonyogo, 49, was arraigned in New York Supreme Court, Kings County, by the Honorable Danny K. Chun. According to the indictment, Atumonyogo used a fraudulent social security number to enroll Monack as a Medicaid-participating provider of medical supplies. The company then allegedly filed false claims to Medicaid and Healthfirst that Monack had dispensed to pediatric patients a highly specialized and expensive enteral nutritional formula, which is prescribed by physicians for patients who must obtain nutrients via a feeding tube and cannot metabolize dietary nutrients from substantive food. NY

May 2, 2017

Maine dentist Joseph W. Griffin agreed to pay $90,000 to resolve allegations he violated the False Claims Act by submitting submitted false claims to MaineCare (Maine’s Medicaid program) for dental services not rendered, were medically unnecessary, or were so inadequately documented in the patient’s medical record as to be unreviewable. DOJ (DME)

March 30, 2017

Godwin Oriakhi, owner of five Houston-area home health agencies pleaded guilty to conspiring to defraud Medicare and the State of Texas’s Medicaid-funded Home and Community-Based Service and Primary Home Care programs of more than $17 million.  According to his plea, Oriakhi admitted that he, his daughter and co-defendant Idia Oriakhi, and other members of his family owned and operated: Aabraham Blessings LLC, Baptist Home Care Providers Inc., Community Wide Home Health Inc., Four Seasons Home Healthcare Inc. and Kis Med Concepts Inc., and that they obtained patients for these home health agencies by paying illegal kickback payments to patient recruiters and his office employees for hundreds of patient referrals.  Oriakhi also admitted that they paid Medicare and Medicaid patients by cash, check, Western Union and Moneygram for receiving services from his family’s home health agencies in exchange for the ability to use their Medicare and Medicaid numbers to bill the programs for home healthcare. DOJ