Medical Devices and DME
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April 29, 2022
Eargo Inc., which sells direct-to-consumer hearing aid devices to customers nationwide, has agreed to pay $34.37 million to resolve allegations of defrauding the Federal Employees Health Benefits Program (FEHBP) over a four-year period. Eargo allegedly submitted or caused to be submitted claims that contained unsupported diagnosis codes, even though an internal review of its billing and coding practices should have detected the error. DOJApril 21, 2022
Susan H. Poon, 57, will spend 70 months in federal prison, and will pay nearly $1.4 million in restitution for a scheme spanning over 3 years, and which resulted in approximately $2.2 million in fraudulent billings. Poon submitted prescriptions both with PII obtained at health fairs held by Costco and UPS, and by soliciting information from actual patients about their dependents—dependents whom Poon never saw or treated. Poon used the stolen PII to submit fraudulent durable medical equipment prescriptions to a DME manufacturer, who then unknowingly submitted false claims for reimbursement to a health insurer. In addition to the prison sentence and the owed restitution, Poon’s chiropractic license was revoked in 2019. USAO CDCAMarch 24, 2022
A New York woman who defrauded the state out of millions of dollars has been sentenced to 3 to 9 years in prison and ordered to pay more than $4 million in restitution. According to the Attorney General’s Office, Leslie Montgomery lured low-income New Yorkers to Health Living Community Center under the guise of helping them find housing, then used their information to submit false claims to a Medicaid-funded managed care organization. The claims for custom-molded back braces were medically unnecessary and not requested by or provided to the intended recipients. Montgomery then hid the illegal proceeds through multiple shell companies, including LCM Livery P/U, Inc. NY AGJanuary 12, 2022
A diabetic shoe company, Foot Care Store, Inc., d/b/a Dia-Foot, and its President and CEO, Robert Gaynor, have agreed to pay $5.5 million to resolve allegations of billing Medicare and Medicaid for custom diabetic shoe inserts when in fact, their inserts were made using generic foot models. The alleged misconduct occurred between 2013 and 2018 and was revealed in a whistleblower’s 2018 qui tam suit. In addition to the monetary penalty, Dia-Foot has entered into a three-year Integrity Agreement that requires the company to implement updated policies and procedures and submit to quarterly independent review of its claims to Medicare and Medicaid. USAO SDFLTop Ten Healthcare Fraud Recoveries of 2021
Posted 01/11/22
January 5, 2022
Two Florida men, Reinier Gonzalez Caballero and Alexeis Napoles Manresa, have each been sentenced to a little over four years in prison for laundering the ill-gotten proceeds of a $3 million healthcare fraud scheme against Medicare. Over a couple months in 2019, durable medical equipment company Universal Ortho Supplies, Inc. billed Medicare for orthosis and prosthetics that were never prescribed by physicians, nor provided to patients. The reimbursements were then turned over to the defendants, who attempted to disguise the source of the funds by setting up shell corporations and opening up fake bank accounts. Two co-conspirators have already been convicted and sentenced; another two have pleaded guilty and await sentencing. USAO SDFLDecember 8, 2021
The owner and medical director of Georgia’s Milton Hall Surgical Associates, Jeffrey M. Gallups, will pay $3 million, and medical device manufacturer Entellus Medical will pay $1.2 million, to resolve claims that they entered into an unlawful kickback arrangement. The government alleged that Gallups received cash payments and all-expense paid trips from Entellus in return for directing MHSA physicians to utilize sinuplasty related medical devices exclusively from Entellus and increase the number of sinuplasty procedures performed. In addition, Gallups was alleged to have received “commissions” from medical testing laboratory NextHealth, in exchange for directing MHSA doctors to order medically unnecessary toxicology and genetic tests from NextHealth. The settlement resolves a qui tam action initiated by former MHSA physician Myron Jones, M.D., who will receive approximately $614,000 from the settlement. USAO ND GARecent Settlements Show Kickbacks are Always a DOJ Enforcement Priority
Posted 11/15/21
