Medicare
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Gordon Schnell and Max Voldman Published in Newsweek on How Whistleblowers are Key to Reining in Prescription Drug Costs
Posted 04/21/22
April 13, 2022
Pharmacy owner Aleah Mohammed was sentenced to 78 months in prison for stealing more than $6.5 million from the government via her prescription fraud on Medicare and Medicaid drug plans. Mohammad submitted claims for drugs that weren’t dispensed, weren’t prescribed as claimed, were not medically necessary, or that were dispensed while the pharmacy was no longer registered with the State of New York. The proceeds were used by Mohammed and her family members to buy luxury vehicles, jewelry, and properties in Queens and Pocono Pines, Pennsylvania. USAO EDNYApril 12, 2022
Physician Partners of America LLC (PPOA), its founder Rodolfo Gari, and its former chief medical officer Dr. Abraham Rivera, have agreed to pay $24.5 million to settle allegations of violating the Stark Law, False Claims Act, and Financial Institutions Reform, Recovery and Enforcement Act (FIRREA). The settlement resolved claims by whistleblowers Donald Haight, Dawn Baker, Dr. Harold Cho, Dr. Venus Dookwah-Roberts, and Dr. Michael Lupi, all currently or formerly employed with PPOA. According to the whistleblowers and the government, PPOA allegedly billed Medicare and Medicaid for medically unnecessary testing, paid illegal kickbacks to its physician employees, and made false statements on a loan from the Paycheck Protection Program. USAO MDFLMarch 31, 2022
Clinical laboratory Radeas LLC has agreed to pay $11.6 million to resolve claims that it submitted false claims to Medicare for medically-unnecessary urine drug tests. As part of the settlement agreement, Radeas admitted that it regularly performed and billed Medicare for essentially simultaneous presumptive qualitative drug testing and confirmatory quantitative drug testing. Without physician review of a presumptive test result, the separate, simultaneous confirmatory test was often not necessary. Radeas also admitted that it paid third-party sales organizations based on the volume of UDT referrals in violation of the Anti-Kickback Statute. USAO MAMarch 3, 2022
New York-based ophthalmologist Ameet Goyal, M.D., who owned and operated Rye Eye Associates, has been sentenced to 8 years in prison and ordered to pay $3.6 million in forfeiture as well as $3.6 million in restitution for submitting $3.6 million in upcoded charges to Medicare, private insurers, and patients between 2010 and 2017. While facing charges for healthcare fraud in 2020, Goyal also falsely certified that he was not facing any criminal charges in order to obtain over $600,000 in loans from the Paycheck Protection Program. USAO SDNYJanuary 28, 2022
Hayat Pharmacy agreed to pay over $2 Million to resolve allegations that it submitted false claims to Medicare and Medicaid for certain prescription medications from its 23 locations. The government alleged Hayat Pharmacy submitted false claims for two prescription medications, a topical cream consisting of iodoquinol, hydrocortisone, and aloe, and a multivitamin with the trade name Azesco. Hayat Pharmacy allegedly switched Medicaid and Medicare patients from lower cost medications to the higher cost medications without any medical need and/or without a valid prescription. As part of the settlement, Hayat Pharmacy agreed to conduct annual training concerning waste, fraud and abuse, and compliance with rules concerning medication switches. USAO WIJanuary 31, 2022
Cardinal Health agreed to pay more than $13 Million to settle allegations it violated the Anti-Kickback Statute and False Claims Act by paying “upfront discounts” to its physician practices. According to the government, Cardinal Health recruited new customers by offering and paying cash bonuses that were not attributable to identifiable sales or were purported rebates which Cardinal Health’s customers had not actually earned. In connection with the settlement, the whistleblowers who brought the case will receive approximately $2.6 million of the recovery. USAO MACatch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme
Posted 01/28/22
Top Ten Financial and Healthcare Fraud Prison Sentences of 2021
Posted 01/28/22
