Catch of the Week: Waived Copayments and “Free” Glucometers Result in $160 Million Recovery in Whistleblower Action Against Previously-Barred Arriva Medical
Posted 08/4/21
Medical Billing Fraud
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August 2, 2021
Diabetic testing supply company Arriva Medical LLC and its parent company Alere Inc. will pay $160 million to resolve claims first brought in a whistleblower case alleging that Arriva provided unlawful patient inducements in the form of “free” or “no cost” glucometers and copayment waivers. Defendants were alleged to have systematically provided all new patients with glucometers, and billed Medicare for those meters, although Medicare beneficiaries are only eligible for a new meter once every five years. In addition, Arriva was alleged to have billed Medicare for deceased beneficiaries. The whistleblower, Gregory Goodman, who was an employee at an Arriva call center, will receive a whistleblower award of $28.5 million. Executives at Arriva previously agreed to a settlement of claims against them. DOJ; USAO MD TennJuly 23, 2021
Alabama non-profit SpectraCare Health Systems, Inc., which provides services including developmental disability services, intermediate care medical services, and behavioral health services, agreed to pay $1 million to resolve claims first brought in a whistleblower action alleging that the provider improperly billed Alabama Medicaid and failed to return overpayments to the Alabama Medicaid Agency. The defendant was alleged to have submitted false claims including claims without correct and complete documentation, and duplicate claims, and to have knowingly retained payments it received to which it was not entitled. The settlement will be split between the federal government and the Alabama Medicaid Agency, with the whistleblower receiving 19% of the federal recovery. USAO MD ALCatch of the Week: EEG Testing Company and Private-Investment Company to Pay $15.3M for Kickback and False-Billing Allegations
Posted 07/23/21
July 22, 2021
Medical laboratory Bluewater Toxicology, LLC, agreed to pay $1.2 million following its self-report of overbilling for urine drug testing services. In billing Medicare, Kentucky Medicaid, Indiana Medicaid, TRICARE, and CHAMPVA, Bluewater was alleged to have submitted false claims that misrepresented the number of drugs tested in definitive urine drug tests, that lacked sufficient documentation, or that were for specimen validity testing that is not separately billable to Medicare. USAO ED KYJuly 21, 2021
Alliance Family of Companies LLC, a national electroencephalography testing company, and Ancor Holdings LP, a private insurance company, have agreed to pay a combined $15.3 million to resolve alleged violations of the False Claims Act and Anti-Kickback Statute. According to a number of whistleblowers, Alliance provided free electroencephalography (EEG) interpretation reports to induce physician orders, caused physicians to submit false claims to the government, used inaccurate billing codes to generate higher reimbursements, and billed for a specialized digital analysis that it didn’t actually perform. The whistleblowers also alleged that while performing due diligence prior to investing in Alliance, Ancor learned of the kickbacks but allowed them to continue after the change in management. Two of the whistleblowers involved will share a reward of nearly $3 million. DOJJuly 20, 2021
Rheumatologist Enrico Arguelles and his practice, Arthritis and Osteoporosis Center of Billings, Montana, agreed to pay $1.27 million and relinquish Medicare claims for $802,000 in settlement of claims that they improperly billed for MRI scans and patient visits, and billed for biologic infusions such as Remicade where the treatment was not medically necessary. USAO MTJuly 19, 2021
Prime Healthcare Services, one of the largest hospital systems in the nation, its founder and CEO Dr. Prem Reddy, and interventional cardiologist Dr. Siva Arunasalam have agreed to pay $37.5 million to resolve two suits filed by former executive Martin Mansukhani, and former employees Marsha Arnold and Joseph Hill. In violation of the federal and California False Claims Acts, certain Prime hospitals had allegedly submitted inflated invoices to Medi-Cal and other government health programs, or submitted claims to Medi-Cal and Medicare under Arunasalam’s provider number for services provided by an excluded physician. Additionally, in acquiring Arunasalam’s physician practice and surgery center, Prime allegedly paid above fair market value for referrals from Arunasalam to one of their hospitals. For being the first to file, one of the whistleblowers, Mansukhani, will receive a relator’s share of nearly $10 million. CA AG; USAO CDCACatch of the Week: Medical Device Companies to Pay $38.75M Over Defective Coagulation Monitor Allegations Linked to Patient Deaths, Injuries
Posted 07/9/21
