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Medicare

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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October 17, 2019

Five home health providers in Iowa and South Dakota have been ordered to pay a combined $3.1 million for submitting false claims to Medicare.  Affiliates of Minnesota-based Welcov Healthcare LLC allegedly billed Medicare for therapy services that were not provided by skilled employees or not medically necessary.  Sergeant Bluff Healthcare, LLC will pay over $1.2 million, Logan Healthcare, LLC and Elk Point Healthcare #1, LLC will each pay over $775,000, Red Oak Healthcare, LLC will pay over $228,000, and Flandreau Healthcare 2, LLC will pay about $116,000.  USAO NDIA

October 10, 2019

Traverse Anesthesia Associates, P.C. (TAA) and six of its anesthesiologists have agreed to pay $607,966 to resolve a partially-intervened qui tam lawsuit jointly filed by two former employees.  In violation of the False Claims Act, TAA allegedly failed to meet regulatory requirements and conditions of payment in submissions to Medicare.  The unnamed whistleblowers will share a $120,000 award.  USAO WDMI

October 9, 2019

Genetic testing company UTC Laboratories, Inc. (RenRX), along with three principals, have agreed to pay a combined $42.6 million to settle six suits alleging violations of the Anti-Kickback Statue and False Claims Act.  Between 2013 and 2017, RenRX and principals Tarun Jolly, M.D., Patrick Ridgeway, and Barry Griffith allegedly paid cash bribes to physician entities and individuals to induce orders of medically unnecessary pharmacogenetic tests that were subsequently billed to Medicare.  As part of the settlement, RenRX also agreed to a twenty-five year period of exclusion from participating in any federal healthcare program.  USAO EDLA

October 9, 2019

The largest operator of kidney dialysis clinics in the United States has agreed to pay $5.2 million to resolve a lawsuit alleging it submitted false claims to Medicare for excessive and unnecessary immune tests.  From 2013 to 2010, Fresenius Medical Care Holdings, Inc. allegedly billed Medicare for Hepatitis B surface antigen tests it performed on patients already known to be immune, at a frequency well above that established by Medicare.  For exposing the alleged False Claims Act violations, former employee Christopher Drennen will receive a 27.5% share of the recovery.  USAO MA

October 4, 2019

Southern California-based Retina Institute of California Medical Group (RIC), its former CEO, and several of its physicians have agreed to pay the State of California and United States $6.65 million to settle alleged violations of state and federal False Claims Acts.  According to former administrators Bobbette Smith and Susan Rogers, between 2006 and 2017, the ophthalmology group improperly billed Medicare and Medicaid for unnecessary and unperformed eye exams, upcoded simple exams using codes normally reserved for emergency conditions, and waived mandatory co-payments and deductibles to induce patient referrals.  Smith and Rogers will receive a relator’s share, which remains to be determined.  USAO CDCA

September 27, 2019

In an investigation dubbed Operation Double Helix, charges have been brought against 35 defendants associated with a number of telemedicine and cancer genetic testing laboratories involved in a scheme that resulted in the submission of more than $2.1 billion in fraudulent Medicare claims.  Cancer genetic testing laboratories involved in the scheme are alleged to have paid illegal kickbacks to providers and others working with fraudulent telemedicine companies in exchange for the referral of Medicare beneficiaries for expensive and medically unnecessary cancer genetic tests, which Medicare was then billed for. Some of the defendants allegedly controlled a telemarketing network that lured hundreds of thousands of elderly and/or disabled patients into signing up for unnecessary genetic tests, often without any interaction with the provider who would prescribe the testing.  DOJ; USAO ED LA

September 25, 2019

Mobile diagnostic service provider Trident USA Health Services LLC has agreed to pay $8.5 million to settle two whistleblower cases alleging violations of the False Claims Act.  Trident’s CIO, Ravi Srivastava, and a regional sales manager, Peter Goldman, had each filed their own qui tam suits alleging Trident had been engaged in a kickback scheme with skilled nursing facilities between 2006 and 2019.  For their efforts, Srivastava will receive $2 million and Goldman will receive $106,250 of the government’s recovery.  USAO EDPA

September 25, 2019

Dhanabapa LLC, doing business as E-Z Pharmacy, and owner Shardaben Patel have agreed to pay $1.1 million to settle allegations of defrauding Medicare and violating the False Claims Act in billing Medicare for prescription medications that were not actually dispensed.  The fraudulent billing occurred from 2012 to 2016 and included medications such as Advair Diskus, Humalog, Novolog, Renvela, and Lidoderm.  USAO EDPA

Catch of the Week — Texas Hospital Exec Sentenced to 10 Years in Prison for Medicare Fraud

Posted  09/18/19
On Monday, a federal judge in Houston sentenced Starsky Bomer, the former CFO and COO of Atrium Medical Center and Pristine Healthcare, to ten years in prison for his role in a Medicare fraud scheme that bilked the government of $16m.  Bomer was convicted by a jury in October of last year.  His co-conspirator, Dr. Sohail R. Siddiqui, took a plea deal in 2017 and is serving five years in prison. Bomer will do time...

September 17, 2019

Physician Alliance Ltd. (PAL) and its medical director agreed to pay $178,000 to resolve False Claims Act allegations for improperly billing Medicare for providing patients with electric acupuncture medical devices that is affixed behind patients' ears. Since Medicare does not reimburse for acupunctural devices, PAL allegedly billed Medicare for the “implantation of neurostimulator electrodes,” a procedure that requires surgery and for which Medicare reimburses in the thousands of dollars. The case was investigated out of the Eastern District of Pennsylvania. DOJ
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