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Medical Billing Fraud

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March 6, 2015

Florida Attorney General Pam Bondi announced the arrest of three men for their alleged involvement in an $11 million multi-state drug diversion ring which involved the purchase of millions of dollars of medications on the black market, primarily from Medicaid recipients in Miami and Newark, and their resale to pharmacies in the Northeast, including North Philly Pharmacy in Philadelphia and Lu Puja Pharmacy in Chicago. FL

February 4, 2015

Pennsylvania Attorney General Kathleen G. Kane and the Office of Inspector General of the U.S. Department of Health & Human Services announced Medicaid fraud and other charges against Philadelphia-based Infinite Care Inc., sister company Infinite Care Special Needs Inc., and the companies’ vice president and treasurer. According to the Grand Jury, Infinite Care fraudulently billed Medicaid by more than $1M for services not rendered from January 2010 to the present, and after the company received a Grand Jury subpoena, it held a meeting where the decision was made to destroy the fraudulent paperwork submitted to the Commonwealth for services not provided and for inflated services. PA

January 16, 2015

Washington Attorney General Bob Ferguson announced Sea Mar Community Health Centers agreed to pay $3.35M to settle charges of improperly billing Medicaid for thousands of dental appointments. According to the government, Sea Mar billed fluoride treatments as stand-alone appointments with a dentist or hygienist when they could have been performed much more cheaply by dental assistants as part of a patient’s regular six-month checkups. WA

October 31, 2014

Oklahoma-based dental company, Ocean Dental PC, which operates 28 clinics in seven states, agreed to pay more than $5M to settle charges it violated the False Claims Act by submitting false claims to the Oklahoma Medicaid program for dental work never performed or billed at a higher rate than allowed. The charges apparently stem from dental restorations by former employee Robin Lockwood who was sentenced to 18 months in federal prison in a separate case. NewsOK

August 12, 2014

New York Attorney General Eric T. Schneiderman announced that the Northern Manor Multicare Center nursing home agreed to pay $6.5M to resolve allegations it was not providing services as represented in its claims for payment to Medicaid. NYAG

April 14, 2014

Hope Cancer Institute, a cancer treatment facility in Kansas, and its owner Dr. Raj Sadasivan, agreed to pay $2.9M to resolve allegations they violated the False Claims Act by submitting claims to Medicare, Medicaid and the Federal Employee Health Benefits Program for chemotherapy drugs and services not actually provided.  The allegations were first raised in a qui tam lawsuit filed by former employees of the facility Krisha Turner, Crystal Dercher and Amanda Reynolds under the whistleblower provisions of the False Claims Act.  DOJ

August 19, 2013

Shands Teaching Hospital & Clinics agreed to pay $26M to settle allegations that six of its health care facilities submitted false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services. The allegations were first raised in a qui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

Health Line Clinical Laboratories — Medicare Fraud/Unnecessary on Nonexistent Testing ($10 million).

One of our whistleblower attorneys led the representation of two whistleblowers who brought a qui tam action under the False Claims Act alleging the medical laboratory was charging for tests not performed or not necessary. For many of the tests involved, records suggested treating physicians had ordered over inclusive “747” panels, and the defense relied heavily on these order forms. The Department of Justice was persuaded the defendants’ conduct caused the unnecessary testing and intervened. Following the defeat of motions to dismiss and focused discovery the case settled for $10 million. The whistleblowers received 18% of the government recovery.
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