Medicaid Archives - Page 9 of 41

October 28, 2021

Rehab Authority, LLC, a physical therapy provider in Minnesota, has agreed to pay $4 million to resolve allegations by whistleblower Cami Lane that it violated the False Claims Act. RehabAuthority clinics had allegedly submitted false claims to Medicare, Medicaid, TRICARE, and the Veterans Health Administration for one-on-one outpatient physical therapy that was not provided. USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

October 25, 2021

Curant, Inc., which owns pharmacies in Florida and Georgia, has agreed to pay $4.6 million to resolve allegations of paying kickbacks to a third-party marketer, waiving mandatory copays from patients, and overbilling TRICARE for compound pain and scar creams. The alleged misconduct occurred between 2013 and 2015. USAO NDGA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Provider Fraud, Whistleblower Case,

Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing

Posted 10/22/21

Clinical laboratory MD Labs Inc., and co-founders and owners, Denis Grizelj and Matthew Rutledge, settled charges the lab falsely billed Medicare, Medicaid, and other federal payors for pricey and unnecessary urine drug tests. Over a four-year period, the lab regularly ran two different drug tests at once and then sent results from both tests to the ordering healthcare physician simultaneously, according to the...

Tagged in: Catch of the Week, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud, Whistleblower Case,

October 20, 2021

MD Spine Solutions LLC, d/b/a MD Labs Inc., and its owners, co-founders Denis Grizelj and Matthew Rutledge, have agreed to pay up to $16 million to settle fraud allegations raised by an unnamed whistleblower. MD Labs had allegedly billed Medicare, Medicaid, and other federal healthcare programs for presumptive urine drug testing as well as confirmatory urine drug testing run on the same samples, which is frequently baseless or useless. USAO MA

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Other Government Health Programs, Whistleblower Case,

Catch of the Week: Private Equity Firm and Former Executives of a Mental Health Center Reach $25 Million Medicaid Settlement

Posted 10/15/21

dollar bill with Medicaid text ripped through

In recent years there has been a proliferation of private equity firms taking oversight of healthcare entities. These private equity firms have increased their exposure to False Claims Act liability by playing active roles in the operation of healthcare entities, and multiple settlements have been reached over the last two years (on kickbacks and promotion of unapproved use of drug-device systems on pediatric...

Tagged in: Catch of the Week, Defendants, FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud,

October 14, 2021

Owners and executives of Massachusetts mental health provider South Bay Mental Health Center, Inc. have agreed to pay $25 million to resolve claims that they caused the submission of false claims to the state’s Medicaid program, MassHealth, by billing for services provided by unlicensed, unqualified, and improperly supervised staff members in violation of MassHealth regulations. Defendants H.I.G. Growth Partners, LLC and H.I.G. Capital, LLC will pay $19.95 million and defendants Peter J. Scanlon and Kevin P. Sheehan, who held executive and board positions at relevant entities, will pay $5.05 million. The case was initiated by the filing of a whistleblower complaint under the Massachusetts False Claims Act. SBMHC previously agreed to pay $4 million to resolve related charges. Mass

Tagged in: Defendants, FCA State, Healthcare Fraud, Improper Medical Personnel, Medicaid, Medical Billing Fraud, Provider Fraud, Whistleblower Case,

September 15, 2021

A cardiologist in Florida who allegedly billed Medicare and Medicaid for medically unnecessary procedures has agreed to pay $6.75 million to resolve claims under the False Claims Act. Between 2013 and 2019, Dr. Ashish Pal allegedly made misrepresentations in patient medical records to justify ablations and vein stent procedures that were not reimbursable under program rules. Additionally, some of the procedures were later found to have been performed primarily by unqualified ultrasound technicians. As part of the settlement, Pal and Interventional Cardiology & Vascular Consultants, PLC, will enter in a multiyear integrity agreement and comply with training and reporting requirements, as well as a quarterly claims review by an independent organization. USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud,

DOJ Reasserts the Proper Role for Agency Guidance in Fraud Cases

Posted 09/3/21

The Justice Department has quietly rescinded a Trump administration policy that was needlessly undermining the role of government agency guidance. On July 1, 2021, Attorney General Merrick Garland issued a memorandum revoking what is known as the Brand Memo. In her memo, Former Associate Attorney General Rachel Brand had set out a position that defense attorneys scrambled to use to argue for leniency or...

Tagged in: Contract Non-Compliance, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Medicaid, Medicare,

August 26, 2021

In-home care provider At Home Care LLC and its principal, Kevin Cox, will pay a total of $2.9 million to resolve allegations that they overcharged the Oregon Medicaid program, including by altering caregiver scheduling records and falsely billing for hours of in-home care that were not actually provided. The company pleaded guilty to healthcare fraud charges, and agreed to be excluded from government healthcare programs. USAO Or

Tagged in: Criminal Proceedings, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud,

August 25, 2021

A California-based provider of home respiratory services and durable medical equipment has agreed to pay $3.3 million to the United States and States of California and Nevada to settle allegations of defrauding Medicare and Medicaid. The claims against SuperCare Health, Inc. were brought in a 2018 qui tam suit by respiratory therapist Benjamin Martinez, who alleged that the provider billed for non-invasive ventilators (NIVs) that were no longer needed or being used by patients. CA AG; USAO CDCA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medicare, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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