Medicaid

June 4, 2015

Hospital operator Health Management Associates (HMA) and Georgia-based hospital Clearview Regional Medical Center agreed to pay $595,155 to settle charges they violated the False Claims Act through an illegal kickback scheme.  Clearview was previously named Walton Regional Medical Center and owned by HMA during the time period relevant to the lawsuit.  Clearview is now owned by Community Health Systems which purchased HMA in January 2014.  According to the government, HMA’s Walton Regional Medical Center paid kickbacks to Hispanic Medical Management (d/b/a Clinica de la Mama), in return for Clinica’s agreement to send pregnant women to Walton Regional for deliveries paid for by Medicaid, in violation of the federal Anti-Kickback Statute.  As part of the settlement, HMA and Clearview will pay the State of Georgia an additional $396,770 to settle Georgia’s claims under the Georgia False Medicaid Claims Act.  The allegations originated in a whistleblower lawsuit filed by former Walton Regional CFO Ralph D. Williams under the qui tam provisions of the False Claims Act.  He will receive a whistleblower award of $119,031.  DOJ, GA

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services.  Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing.  The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC.  The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be determined whistleblower award. DOJ

April 15, 2015

Mehran Zamani pleaded guilty to a multimillion Medicaid fraud scheme relating to his work for Landmark Dental, Dental Group of Stamford and Dental Group of Connecticut where he served as the front for Gary Anusavice, the real owner of the businesses, who was a convicted felon, former dentist, and excluded Medicaid provider.  FBI

February 2, 2015

Tennessee-based Community Health Systems Professional Services Corporation and three affiliated New Mexico hospitals agreed to pay $75M to settle 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 hospitals. The allegations were first raised in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Community Health revenue manager Robert Baker. He will receive a whistleblower reward of $18,671,561 as his share of the government’s recovery. DOJ

May 19, 2014

Todd Farha, former CEO of WellCare, an operator of health maintenance organizations (HMOs) in several states, was sentenced to serve 36 months in prison for defrauding the Florida Medicaid program. According to court records and evidence at trial, Farha and others orchestrated a scheme to defraud the Florida Medicaid program from the summer of 2003 through the fall of 2007 by making fraudulent statements relating to expenditures for behavioral health care services. Under a prior settlement with the government, WellCare was required to pay $80M in restitution and forfeitures. In a related civil qui tam case filed under the whistleblower provisions of the False Claims Act, Wellcare also paid $137.5M in civil fines and penalties. DOJ

December 2, 2013

Caremark agreed to pay $4.25M to settle allegations that it knowingly failed to reimburse Medicaid for prescription drug costs paid on behalf of Medicaid beneficiaries, who also were eligible for drug benefits under Caremark-administered private health plans. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

January 21, 2016

New York will receive $47 million in a settlement with CenterLight Healthcare and CenterLight Health System, resolving allegations that CenterLight Healthcare’s Select Medicaid Managed Long Term Care Plan fraudulently billed Medicaid for services they did not provide to more than 1,200 Medicaid recipients. Under the settlement, CenterLight Healthcare admitted that it enrolled Medicaid beneficiaries who were referred by social adult day care centers even though the beneficiaries were not eligible to receive managed long-term care under the plan, and that the centers were providing services that did not qualify for reimbursement under New York State Department of Health standards, or CenterLight’s contract with DOH.  Whistleblower David Heisler will receive a yet-to-be-determined whistleblower award. NY

October 7, 2015

In New York, two individuals who owned and operated two transportation companies, were arrested for allegedly violating the Workers’ Compensation law and illegally obtaining over $1 million from the Medicaid system. Yellow Medi-Van and Taxi, Inc. received payments from the Medicaid Program for transporting Medicaid beneficiaries to medical appointments. The defendants are alleged to have knowingly operated the company in violation of transportation regulations, including not having worker’s compensation insurance. During the time the company was operated unlawfully, the companies obtained over $1 million in Medicaid payments. NY

September 29, 2015

The New Jersey Medicaid Fraud Control Unit and Office of the Insurance Fraud Prosecutor obtained an indictment against a doctor, Syed Jaffery, for accepting kickbacks in exchange for patient referrals. The indictment alleges that from 2010 to 2013, Jaffrey participated in a scheme by which he agreed to refer patients needing MRI and CT scans to Diagnostic Imaging Services of South Jersey in exchange for monetary kickbacks. Over the course of the scheme, Jaffrey allegedly accepted approximately $195,000. In an attempt to disguise the arrangement, the kickback checks were made payable to Jaffrey’s alleged shell company Mask Realities and purported to be for a rental space for billing services. NJ