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Medical Billing Fraud

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January 22, 2018

Maryland announced it has joined the United States, the District of Columbia, and 19 other states in a settlement agreement relating to allegations against Benevis, LLC (formerly known as NCDR, LLC) and 133 Kool Smiles clinics that received non-clinical practice support from Benevis, LLC. Maryland will receive $1.022 million as a result of the settlement. The settlement will resolve allegations that Benevis/Kool Smiles knowingly submitted or caused to be submitted false claims to the Medicaid program related to dental services provided to pediatric patients. Under the settlement, Benevis/Kool Smiles agreed to pay $23.9 million collectively to the federal and state governments. The participating states will share $9.65 million of the total settlement. MD

December 29, 2017

Maryland physician Nwaehihie H. Onyeaghala of Krystal Medical Associates, LLC agreed to pay $1 million to settle allegations he violated the False Claims Act by submitting false claims to Medicare for medically unnecessary autonomic nervous function tests and peripheral vascular tests.  According to the government, the tests were not medically necessary because Dr. Onyeaghala lacked the necessary equipment to conduct the tests, the patients did not have an autonomic nervous function disorder before the test was conducted, Dr. Onyeaghala lacked the specific training to conduct such tests and he only used the tests to monitor patient symptoms, not make any clinical decisions about future patient care.  DOJ (DMD)

December 21, 2017

Rhode Island-based Dominion Diagnostics, Inc. agreed to pay $815,000 to resolve claims of violating the False Claims Act by presenting claims to Medicare and Vermont Medicaid for urine specimen validity testing when referring physicians did not specifically order the testing. DOJ (DVT)

December 14, 2017

Texas-based DaVita Rx LLC, a nationwide pharmacy that specializes in serving patients with severe kidney disease, agreed to pay $63.7 million to resolve charges of violating the False Claims Act by billing Medicare for prescription medications never shipped, shipped but subsequently returned, and that did not comply with requirements for documentation of proof of delivery, refill requests, or patient consent. The settlement also resolves allegations that DaVita paid financial inducements to Medicare beneficiaries in violation of the Anti-Kickback Statute. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by two former DaVita employees Patsy Gallian and Monique Jones. The whistleblowers will receive an award of $2.1 million from the proceeds of the government's recovery. DOJ

December 14, 2017

Mississippi-based Region 8 Mental Health Services agreed to pay roughly $7 million resolve charges of violating the False Claims Act allegations by submitting claims for services not provided or not provided by qualified individuals as part of its preschool Day Treatment program. It is believed to be the largest False Claims Act healthcare settlement in the history of the State of Mississippi. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Region 8 employee. The whistleblower will receive an award of more than $1 million from the proceeds of the government's settlement. DOJ (SDMS)

December 12, 2017

Med-Fast Pharmacy, Inc. agreed to pay roughly $2.7 million to resolve both criminal and civil charges of violating the False Claims Act relating to the conduct of Iserve Technologies, Inc., a company co-located with and operated out of Med-Fast, filling prescriptions for nursing homes with recycled unused drugs that were commingled with drug stocks on hand at Med-Fast’s Institutional Pharmacy. The settlement also resolves allegations that Med-Fast sought Medicare and Medicaid reimbursement for the retail-packaged version of diabetes testing strips while actually supplying patients with cheaper mail-order-packaged version of the same strips. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower will receive a yet-to-be-determined award from the proceeds of the government's recovery. DOJ (WDPA)

New Jersey Doctor and Son Sentenced to Prison for Medicare Fraud

Posted  12/19/17
By the C|C Whistleblower Lawyer Team New Jersey doctor Robert Claude McGrath and his chiropractor son Robert Christopher McGrath were sentenced to prison for conspiring to defraud Medicare by using unqualified people to give physical therapy to Medicare recipients.  The pair, sentenced to 30 and 12 months respectively, previously pleaded guilty to the charges.  They also were ordered to pay restitution of...

November 30, 2017

Florida-based Express Plus Pharmacy, LLC and its owner Antonio Primo agreed to pay $170,000 to resolve allegations they violated the False Claims Act by submitting fraudulent claims to Tricare for compounded medications such as pain creams that were not reimbursable because they were not issued pursuant to valid physician-patient relationships, were issued after brief phone calls with patients that violated applicable law on telemedicine, were medically unnecessary, and/or were tainted by kickbacks to marketers.  DOJ (SDFL)

November 16, 2017

Georgia-based not-for-profit Hyperion Foundation, its former president Julie Mittleider, Georgia-based nursing home management company AltaCare Corporation, its CEO Douglas Mittleider, and related companies Long Term Care Services Inc. and Sentry Healthcare Acquirors Inc. agreed to pay $1.25 million to resolve allegations of violating the False Claims Act by providing grossly substandard care to residents at the Oxford Health and Rehabilitation nursing home in Mississippi when it was operated by AltaCare under a contract with Hyperion.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act by Academy Health Center Inc., the owner and landlord of the Mississippi skilled nursing facility.  Academy will receive a whistleblower award in an undisclosed amount from the proceeds of the government's recovery.  DOJ
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