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Catch of the Week: Another Pharma Company, Incyte, Settles FCA Claims For Kickbacks to a Charitable Foundation

Posted  05/7/21
By Edward Baker
pills scattered around
The Department of Justice announced this week that Incyte Corporation, a Delaware pharmaceutical company, has agreed to pay $12.6 million to resolve allegations that it violated the False Claims Act by paying kickbacks to a charitable foundation to increase prescriptions for the drug Jakafi, which is used to treat myelofibrosis, a form of leukemia that causes extensive scarring in bone marrow and leads to severe...

May 5, 2021

Neurosurgical Associates, LTD and Dignity Health, d/b/a St. Joseph’s Hospital, have agreed to a $10 million settlement and five-year corporate integrity agreement to resolve allegations of violating the federal False Claims Act.  According to whistleblower Dr. Bruce P. Kingsley, Neurological Associates and St. Joseph’s Hospital improperly billed Medicare for certain doubly and triply concurrent and overlapping surgeries.  USAO AZ

May 4, 2021

Delaware-based pharmaceutical company Incyte Corporation has agreed to pay $12.6 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act in connection with its myelofibrosis drug, Jafaki.  Despite federal laws against illegal remuneration to federal healthcare program beneficiaries, Incyte allegedly wielded its influence as the sole donor of a foundation to coerce the foundation into illegally covering the copays of Medicare and TRICARE patients taking Jafaki.  The misconduct continued from 2011 through 2014 before it was revealed in a qui tam suit by former compliance executive turned whistleblower, Justin Dillon.  Dillon will receive approximately $3.59 million for his efforts.  DOJ; USAO EDPA

May 4, 2021

After being convicted of running a $11 million healthcare fraud scheme, Brenda Rodriguez, the owner and operator of Texas-based QC Medical Clinic, has been ordered to spend 25 years in prison, followed by 3 years of supervised release.  As shown by evidence presented at trial, Rodriguez’s scheme involved paying doctors to approve Medicare beneficiaries for home health services, selling the approvals to various home health providers, and causing the providers to bill Medicare for services that were medically unnecessary, never provided, and/or arose from illegal inducements.  USAO SDTX

April 29, 2021

Over two dozen defendants who were part of an extensive prescription drug fraud scheme involving Alabama-based Northside Pharmacy d/b/a Global Compounding Pharmacy have been sentenced to prison.  The defendants included company executives and managers, prescribers, billers, and sales representatives who, between 2013 and 2016, billed insurers such as Medicare and TRICARE for massive quantities of medically unnecessary prescription drugs.  In just that short period of time, the defendants caused insurers to pay nearly $50 million in medically unnecessary claims, with more than $13 million arising from improper payments to prescribers, and more than $8.4 million for prescriptions written out to Global employees themselves.  USAO NDAL

April 21, 2021

Tennessee-based Anesthesia Services Associates, PLLC d/b/a Comprehensive Pain Specialists (CPS) and its four majority owners have agreed to pay a total of $4.1 million to resolve allegations of violating the federal False Claims Act and Tennessee Medicaid False Claims Act.  According to the government, CPS billed Medicare and TennCare for medically unnecessary or non-reimbursable genetic tests, psychological tests, specimen validity tests, and urine drug tests, as well as medically unnecessary or non-reimbursable acupuncture.  For bringing a successful qui tam suit, the whistleblowers in this case will receive a relator’s share of over $610,000.  USAO MDTN

April 20, 2021

In order to resolve a whistleblower suit alleging violations of the False Claims Act, Massachusetts Eye and Ear and its related entities have agreed to pay over $2.6 million.  Over an eight-year period ending in 2020, Massachusetts Eye and Ear allegedly made a habit of submitting false claims to Medicare and Medicaid for office visits that were not reimbursable under program rules.  Altogether, the government programs were defrauded of over a million dollars.  As a reward for blowing the whistle, the unnamed relator will receive a 15% share of the settlement proceeds.  USAO MA

Catch of the Week: Telemarketer Gets 10 Years in $3.3 Million Telemedicine and Genetic Testing Fraud Scheme

Posted  04/16/21
female looking through a lab telescope
Ivan Andre Scott, a 36-year-old Florida man, just landed a 10-year prison sentence for organizing a $3.3 million Medicare fraud scheme involving two of the hottest healthcare trends – telemedicine and genetic testing to assess the likelihood of future cancer. The conspiracy targeted vulnerable Medicare beneficiaries for pricey cancer screening genetic tests, prosecutors said. Claims for these tests were falsely...

April 14, 2021

The owner of a Florida-based telemarketing call center, Ivan Andre Scott, has been sentenced to 10 years in prison after being convicted of conspiracy to commit healthcare fraud in connection with a $3.3 million fraud scheme against Medicare.  According to evidence presented at trial, Scott made telemarketing calls to Medicare beneficiaries to persuade them to take expensive genetic tests, paid illegal kickbacks to telemedicine companies in exchange for doctor authorizations, and received illegal kickbacks from laboratories in exchange for providing them with the genetic tests.  DOJ

April 13, 2021

After pleading guilty to one count of conspiracy to commit healthcare fraud, James Spina of Dolson Avenue Medical (DAM) in New York has been sentenced to 9 years in prison and ordered to pay over $9.7 million in restitution and over $9.1 million in forfeiture.  Because he did not meet legal requirements for owning and operating a medical corporation, Spina went to great lengths to conceal his role in DAM and at least four other medical corporations, which he then used to run a widespread fraud scheme against Medicare and other health insurers.  The misconduct involved submitting fraudulent claims for medically unnecessary services and services not rendered, double billing for services, fabricating medical records, and obstructing audits by Medicare and other health insurers.  USAO SDNY
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