Medicaid

March 7, 2022

Redwood Toxicology Laboratory has agreed to pay nearly $4.8 million to settle allegations that the California-based urine drug testing service overcharged the Connecticut Medicaid program for certain laboratory services, in violation of Connecticut’s “Most Favored Nation” regulation, which provides that the state should not be charged more than the lowest price charged to third parties.  The settlement covered claims submitted between January 2015 through February 2018.  USAO CT

February 2, 2022

New York healthcare provider The Door - A Center for Alternatives has agreed to pay $12.9 million to resolve claims that it submitted false claims for reimbursement to New York's Indigent Care Pool, which is funded by Medicaid.  The Door was required to submit annual cost reports to New York reporting figures including the number of "threshold visits" to its ambulatory diagnostic and treatment center.  A qui tam case initiated by two whistleblowers alleged that defendant knowingly inflated the number of threshold visits to increase payments.   SDNY

February 1, 2022

Two North Carolina medical providers will pay nearly $1.5 million combined for submitting false claims to the Medicaid program. Knowles, Smith, & Associates LLP will pay $1,150,000 to resolve allegations spanning five years of failure to monitor their anesthesia billing by not providing services billed, administering medically unnecessary procedures, or failing to maintain sufficient supporting documentation. Stacy Benton Lewis, M.D., and the Center for Women’s Health, P.A. will pay $340,000 to resolve false billing allegations covering a four-year period for submitting claims for complex visits that did not occur. NC DOJ

January 28, 2022

Hayat Pharmacy agreed to pay over $2 Million to resolve allegations that it submitted false claims to Medicare and Medicaid for certain prescription medications from its 23 locations. The government alleged Hayat Pharmacy submitted false claims for two prescription medications, a topical cream consisting of iodoquinol, hydrocortisone, and aloe, and a multivitamin with the trade name Azesco.  Hayat Pharmacy allegedly switched Medicaid and Medicare patients from lower cost medications to the higher cost medications without any medical need and/or without a valid prescription. As part of the settlement, Hayat Pharmacy agreed to conduct annual training concerning waste, fraud and abuse, and compliance with rules concerning medication switches. USAO WI

January 6, 2022

Centene Corporation will pay $21.15 million to resolve claims that the pharmacy benefit manager inaccurately reported its services and costs to New Hampshire’s Medicaid Care Management Program, resulting in overcharges to the state.  NH (related settlements with Ohio, Mississippi, and Kansas)

December 2, 2021

Texas-based Flower Mound Hospital Partners LLC has agreed to pay $18 million and enter into a five-year Corporate Integrity Agreement to resolve fraud allegations.  According to Leslie Jennings, M.D., one of many physician-owners, when Flower Mound repurchased shares from physician-owners nearing retirement age and resold them to younger physicians, the company allegedly improperly took into account the value of each physician’s referrals in selecting to whom and how many shares would be resold.  Claims arising from these referrals were then knowingly submitted to Medicare, Medicaid, and TRICARE, in violation of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act.  For initiating a lawsuit that resulted in a successful enforcement action, Jennings will receive a $3 million share of the settlement.  DOJ