Medicaid
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June 5, 2015
Atlanta-based dental practice Dennis B. Jaffe D.M.D., P.C. and its principal Dennis Jaffe agreed to pay $324,327.05 to settle charges they violated the False Claims Act by fraudulently billing Medicaid for tooth extraction procedures and for fraudulently billing for services rendered by a dental assistant when Jaffe was not present in the office. According to the government, Jaffe fraudulently sought payment from Medicaid for higher and more expensive levels of service than were actually performed, a practice commonly referred to as “upcoding.” The allegations first arose in a whistleblower lawsuit filed by Michelle Smith under the qui tam provisions of the False Claims Act. DOJJune 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, GAJune 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. DOJApril 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. FBIFebruary 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. DOJDOJ Catch of the Week -- CenterLight Healthcare
Posted 01/22/16
By the C|C Whistleblower Lawyer Team
This week's Department of Justice "Catch of the Week" goes to New York-based CenterLight Healthcare, Inc. and CenterLight Health System, Inc. Yesterday, the companies agreed to pay $46.7 million to resolve allegations that they violated the federal and New York State False Claims Acts by enrolling ineligible members in their Medicaid managed long-term care plan. ...