Medical Billing Fraud

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

November 7, 2017

Detroit-area doctor Johnny Trotter was sentenced to 180 months in prison and to pay roughly $9 million in restitution for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided and efforts to circumvent Medicare’s investigation of the fraudulent scheme.  DOJ

October 30, 2017

Ohio-based Chemed Corporation and various wholly-owned subsidiaries, including Vitas Hospice Services LLC and Vitas Healthcare Corporation, agreed to pay $75 million to resolve charges they violated the False Claims Act by submitting claims for hospice services to Medicare for patients not terminally ill.  Vitas is the largest for-profit hospice chain in the United States and was acquired by Chemed in 2004.  The government alleged the defendants rewarded employees with bonuses for the number of patients receiving hospice services, without regard to whether they were actually terminally ill and whether they would have benefited from continuing curative care.  The government further alleged that Vitas submitted false claims to Medicare for continuous home care services that were not necessary, not actually provided, or not performed in accordance with Medicare requirements.  The allegations originated in several whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  The whistleblowers will receive a portion of the proceeds of the government's recovery.  DOJ

October 24, 2017

A federal judge awarded the government roughly $2 million in a verdict against Maryland-based home health care company Dynamic Visions, Inc. for violating the False Claims Act because its employees repeatedly and routinely falsified records to obtain funds from Medicaid.  Specifically, a government investigation found many of the company's patient files did not contain physician authorizations, called “plans of care,” as required under applicable regulations; contained plans of care that were not signed by physicians or other qualified health care workers; or contained forged signatures in order to cover up the lack of a physician’s authorization. DOJ (DDC)

October 3, 2017

New York Anesthesiology Medical Specialties, P.C. (d/b/a New York Spine and Wellness Center) agreed to pay roughly $2 million to resolve claims it violated the False Claims Act by improperly billing the government for moderate sedation services.  DOJ (NDNY)

September 27, 2017

South Carolina hospital AnMed Health agreed to pay over $7 million to resolve allegations it violated the False Claims Act by knowingly disregarding the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.  Specifically, the government alleged that AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former AnMed Health employee Linda Jainniney.  She will receive a whistleblower award of roughly $1.2 million from the proceeds of the government's recovery.  DOJ (NDGA)

September 7, 2017

Connecticut substance abuse treatment provider the Hartford Dispensary and the Hartford Dispensary Endowment Corporation and its former CEO Paul McLaughlin agreed to pay $627,000 to resolve allegations they violated the False Claims Acts by falsely representing and certifying to federal and state authorities that Hartford Dispensary had a medical director, as defined by relevant regulations, who was performing the duties and responsibilities required by federal and state law.  The allegations originated in a whistleblower lawsuit filed by former Hartford Dispensary employees Russell Buchner and Charles Hatheway under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of roughly $113,000 from the proceeds of the government's recovery.  DOJ (DCT)

August 28, 2017

Oklahoma physician Dr. Gordon P. Laird agreed to pay $580,000 to settle allegations he violated the False Claims Act by submitting false claims to Medicare for services he did not provide or properly supervise.  He is a former owner and employee of the companies Blackwell Feet Plus, LLC, and Feet Plus, LLC, which later did business as Prevention Plus. DOJ (WDOK)