Medicare
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January 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 11, 2022
UC San Diego Health has agreed to pay $2.98 million to resolve allegations that it ordered and submitted referrals for medically unnecessary genetic testing, leading to the submission of false claims to Medicare. DOJTop Ten Whistleblower Awards of 2021
Posted 01/6/22
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 2, 2021
Texas-based Flower Mound Hospital Partners LLC has agreed to pay $18 million and enter into a five-year Corporate Integrity Agreement to resolve fraud allegations. According to Leslie Jennings, M.D., one of many physician-owners, when Flower Mound repurchased shares from physician-owners nearing retirement age and resold them to younger physicians, the company allegedly improperly took into account the value of each physician’s referrals in selecting to whom and how many shares would be resold. Claims arising from these referrals were then knowingly submitted to Medicare, Medicaid, and TRICARE, in violation of the Anti-Kickback Statute, Physician Self-Referral Law, and False Claims Act. For initiating a lawsuit that resulted in a successful enforcement action, Jennings will receive a $3 million share of the settlement. DOJDecember 1, 2021
A collection of hospices known as Crossroads Hospice has agreed to pay $5.5 million to settle allegations raised in two qui tam suits by former employees Leanne Malone, Jackie Burns, and Angela Heck, and a home health physician in Tennessee, Dr. David Weber. In their lawsuits, the whistleblowers alleged that between 2012 and 2014, Crossroads billed Medicare for hospice care for patients who were not terminally ill, including patients with Alzheimer’s or dementia. Malone, Burns, and Heck will divide a million-dollar relator’s share. USAO WDTNNovember 9, 2021
Kaléo, Inc., a pharmaceutical manufacturer in Virginia, has agreed to pay $12.7 million to resolve a whistleblower’s allegations that it violated the Anti-Kickback Statute and False Claims Act in claims submitted to Medicare, TRICARE, and the Federal Employees Health Benefits Program. Between 2017 and 2020, kaléo allegedly provided kickbacks to physicians and their staff to induce and reward them for prescribing Evzio, a higher-priced version of a drug used to reverse opioid overdoses and which often requires prior authorization. Kaléo also allegedly directed pharmacies to submit false prior authorizations and dispense Evzio without collecting required co-pays. USAO MACatch of the Week: Classic Medicare Fraud
Posted 11/5/21
