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This archive displays posts tagged as relevant to Medicare and fraud in the Medicare program. You may also be interested in our pages:

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Question of the Week — Should providers who defraud Medicare be excluded from it?

Posted  06/18/19
Fortune Cookie with Message with Message Saying "Not Eligible for Medicare!"
Sometimes, though rarely, when a medical provider settles a False Claims Act case or is found to have violated the FCA at trial, they are excluded from participating in healthcare programs as a condition of resolving the case. Often, this is a limited-time ban that is meant to incentivize providers to follow Medicare’s rules in the future and to deter other providers from committing fraud. Between Medicare,...

June 12, 2019

Lake Country Pharmacy and Compounding Center in Georgia, along with two of its principals, Chris and Carey Vaughan, have settled allegations filed by a whistleblower under the federal False Claims Act and Georgia False Medicaid Claims Act.  According to former pharmacist Chris Coleman, Lake Country submitted bills to Medicare, Medicaid, and TRICARE for compounded medications that were made from non-reimbursable bulk powders but billed as if they were made from reimbursable tablets.  Without admitting or denying these charges, Lake Country agreed to pay $365,000 and enter into an Integrity Agreement with the Department of Health and Human Services.  USAO MDGA

June 11, 2019

A physical therapy center, its owner, and four nursing facilities in the Chicago area have settled an intervened qui tam suit that alleged that they upcoded patient Resource Utilization Group (RUG) scores, in violation of the False Claims Act, in order to increase Medicare payments.  Quality Therapy & Consultation Inc and owner Francise Parise allegedly worked in conjunction with Carlton at the Lake Inc, Ridgeview Rehab and Nursing Center, Lake Shore Healthcare and Rehabilitation Centre LLC, and Balmoral Home Inc to manipulate the RUG scores, which indicate the level of skilled nursing care each patient requires.  By upcoding the scores, the defendants allegedly claimed higher reimbursement rates from Medicare.  As part of the settlement, each of the facilities will pay between $1 and $4 million, and Parise will pay $160,000, for a combined recovery of $9.7 millionUSAO NDIL

June 11, 2019

A Maryland-based medical device manufacturer facing criminal charges and civil charges under the False Claims Act has agreed to pay $15 million to settle all claims.  According to former employee and whistleblower John Murtaugh, when the company discovered that its MicroMatrix wound dressing powder was contaminated with high levels of endotoxins, it allegedly removed certain MicroMatrix products off the market, but failed to report the removal to the FDA and disclose the reason to doctors, hospitals, and its own sales representatives.  ACell also allegedly caused false claims to be submitted to federal healthcare programs by directing its sales representatives to market the product as safe and effective, providing coding recommendations designed to elicit higher payments from Medicare, and providing improper inducements to encourage use of its product.  As part of the settlement, Murtaugh will receive $2.3 million, and ACell will enter into a 5-year corporate integrity agreement.  DOJ

June 7, 2019

Robert A. Glazer and Marina Menino have been found guilty at trial for their actions directing a Medicare fraud scheme that billed $33 million to the government.  Menino received kickbacks from Glazer in exchange for recruiting patients for his Glazer Clinic.  Glazer then billed Medicare for services the patients did not need or did not receive, referred them to medically unnecessary home health or hospice services, and ordered durable medical equipment that they did not need or receive. Defendants will be sentenced in September 2019. DOJ; USAO C.D.Cal.

Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Posted  06/7/19
businessmen showing inside of briefcase
Opioid manufacturer Insys Therapeutics agreed to a $225 million settlement related to allegations that it unlawfully marketed its drug Subsys and paid kickbacks to providers through “speaker programs” that rewarded providers who prescribed Subsys. We previously asked whether our readers thought CEOs should be more liable for corporate wrongdoing after the Insys CEO was convicted for participating in a criminal...

June 3, 2019

A former physician’s assistant in New Hampshire has been sentenced to 4 years in prison for writing prescriptions of a fentanyl spray in exchange for over $49,000 in kickbacks masked as speaker honorariums.  After being approached by a drug manufacturer in 2013, Christopher Clough wrote upwards of 750 prescriptions for the spray, which was intended for management of breakthrough cancer pain (BTCP).  Over 215 of those prescriptions were for Medicare and TRICARE patients and led to payments of over $2.1 million by Medicare and almost $600,000 by TRICARE.  On top of the kickback charges, Clough was accused of causing patient harm for prescribing the drug, in high doses, to patients who didn’t have BTCP, and then rebuffing patient and family requests to get off the drug.  USAO NH

May 31, 2019

A Kansas hospital accused of submitting false claims to Medicare and Medicaid has agreed to pay $250,000 to settle a qui tam suit by Bashar Awad and Cynthia McKerrigan, with about $50,000 of the recovery going to the whistleblowers.  According to the suit, from 2012 to 2013, Coffey Health System falsely attested to having conducted or reviewed security risk analyses of electronic health records (EHR), which was a requirement under a federal incentive program that pays healthcare providers for adopting certified EHR technology.  USAO KS

May 29, 2019

Houston-based patient recruiter and home health clinic owner Egondu “Kate” Koko has been sentenced to over 15 years in prison and ordered to pay $14 million for participating in a $20 million kickback scheme involving Medicare beneficiaries.  Koko had plead guilty in October to paying bribes to both physicians and patients in order to earn between $9.5 and $25 million in ill-gotten gains, as well as to laundering money under another person’s identity and using proceeds from the fraud to buy a home.  DOJ

May 29, 2019

Almirall, LLC, f/k/a Aqua Pharmaceuticals, LLC , will pay $3.5 million to settle kickback allegations exposed by a former Aqua sales representative.  According to the whistleblower, the pharmaceutical company paid kickbacks in the form of free meals, trips, gift cards, and gifts, to dermatology providers in exchange for prescriptions of their drugs to Medicare and TRICARE patients.  It also paid kickbacks by compensating healthcare providers for speaking engagements and consulting services. For coming forward with details of the fraud, the unnamed whistleblower will receive a $735,000 share of the recovery.  USAO EDPA
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