Medicaid

February 7, 2017

Florida physician Gary L. Marder, and the owner of the Allergy, Dermatology & Skin Cancer Centers in Port St. Lucie and Okeechobee, stipulated to a consent final judgment of over $18 million to settle False Claims Act allegations that Dr. Marder submitted claims to federal healthcare programs for medically unnecessary biopsies and radiation therapy services, radiation therapy services performed in contravention of standard practice regarding the amount of time between radiation treatments, and radiation therapy services performed without direct supervision and by unlicensed and/or unqualified physician assistants.  Dr. Kendall also allegedly submitted false claims to federal and state healthcare programs for laboratory services tainted by kickbacks to, and improper financial relationships with, Dr. Marder.  The allegations originated in a whistleblower lawsuit filed by Dr. Theodore A. Schiff under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (SDFL)

February 6, 2017

U.S. hospital service provider TeamHealth Holdings (as successor in interest to IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc.), agreed to pay $60 million to resolve allegations it violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed (a practice known as “up-coding”).  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist.  He will receive a whistleblower award of roughly $11.4 million.  DOJ

February 2, 2017

Pain management physician Dr. Robert Windsor, owner of National Pain Care, Inc. which owns pain management clinics in Georgia and Kentucky, agreed to the entry of a $20 million consent judgment to resolve allegations he violated the False Claims Act by billing federal health care programs for surgical monitoring services he did not perform and for medically unnecessary diagnostic tests.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Kris Frankenberg, Stephanie Herder and Bradley Davis.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government’s recovery.  Whistleblower Insider

February 25, 2017

New York announced the arrest of Kester Atumonyogo, 43, of Valley Stream, N.Y., and his company Monack Medical Supply, Inc. (“Monack”) for allegedly stealing over $1.5 million from Medicaid and Healthfirst, a Medicaid managed care organization. The defendants are accused of using a false Social Security number to enroll Monack as a participating medical supply provider in Medicaid. Thereafter, the company allegedly filed false claims that misrepresented to Medicaid and Healthfirst that Monack dispensed a highly specialized, expensive enteral, nutritional formula to needy pediatric patients. Enteral nutritional formulas are prescribed by physicians for patients who must obtain nutrients via a feeding tube and cannot metabolize dietary nutrients from substantive food. The Medicaid reimbursement rate for specialized enteral, nutritional formula is substantially higher than off-the-shelf or over-the-counter nutritional supplements. The Attorney General’s investigation conducted by the Medicaid Fraud Control Unit (MFCU) revealed that Medicaid and Healthfirst, relying on Monack’s false claims, paid Monack for specialized enteral, nutritional formula, but that Monack only dispensed “Pediasure” or similar over-the-counter nutritional supplements to Medicaid patients, when it dispensed anything at all. NY

February 17, 2017

A Wellesley-based dental provider and its billing agent have agreed to pay $1.5 million to Massachusetts’ Medicaid program (MassHealth) to resolve allegations of improper billing for visits to MassHealth members living in nursing homes. The settlement resolves allegations that dental provider Alec H. Jaret, DMD, PC d/b/a HealthDrive Dental Group and its billing agent, HealthDrive Corporation, overbilled MassHealth for nursing home visits. The AG’s Office filed a complaint against the defendants in March 2014 alleging that between July 2010 and September 2013, HealthDrive, on behalf of HealthDrive Dental Group, overbilled MassHealth for nursing home visits by charging a separate “house call” fee for multiple patients treated at the same facility on the same day. An investigation by the AG’s Office revealed that HealthDrive was paid for more than 34,700 excessive claims on a per-patient per-day basis, contrary to MassHealth’s regulations on dental house calls established in 2010. The parties have reached a civil settlement agreement pursuant to which HealthDrive and HealthDrive Dental Group will pay MassHealth $1,500,756 to resolve all claims. MA

February 1, 2017

Iowa nursing facility the Abbey of Le Mars, Inc., and other individuals with financial interests in the Abbey’s operations, agreed to pay $100,000 to settle allegations they violated the False Claims Act by submitting or causing claims to be submitted to Medicaid when the care provided to nursing facility residents was so grossly substandard it was worthless and effectively without value.  DOJ (NDIA)

January 27, 2017

Brooklyn residents Olga Proskurovsky, Yuriy Omelchenko and Isak Aharanov pleaded guilty in connection with a health care fraud scheme involving two Brooklyn clinics that caused approximately $55 million in false claims to Medicare and Medicaid.  They agreed to forfeiture money judgments in the amount of roughly $17 million.  Proskurovsky served as a medical biller and Omelchenko worked as a therapist manager at Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. where they assisted in a scheme to defraud the Medicare and Medicaid programs in which patients subjected themselves to medically unnecessary health services, including physical and occupational therapy, provided by unlicensed staff.  DOJ