Catch of the Week: Laboratory and Two Founders Will Pay up to $16M Over Fraudulent Billing for Urine Drug Testing
Posted 10/22/21
Medicare
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October 20, 2021
MD Spine Solutions LLC, d/b/a MD Labs Inc., and its owners, co-founders Denis Grizelj and Matthew Rutledge, have agreed to pay up to $16 million to settle fraud allegations raised by an unnamed whistleblower. MD Labs had allegedly billed Medicare, Medicaid, and other federal healthcare programs for presumptive urine drug testing as well as confirmatory urine drug testing run on the same samples, which is frequently baseless or useless. USAO MAOctober 8, 2021
U.S. Medical Management, LLC (USMM) and VPA, P.C. (VPA) have agreed to pay $8.5 million to resolve claims raised in five separate qui tam lawsuits that USMM and VPA billed Medicare for medically unnecessary laboratory and diagnostic testing services between 2010 and 2015. Although the government did not join any of the lawsuits, the whistleblower who filed first will receive $1.53 million under the alternate remedy provision of the False Claims Act. USAO EDMICatch of the Week: CMS Suspends UnitedHealth and Anthem Medical Advantage Plans for Charging Too Much in Premiums
Posted 09/24/21
September 15, 2021
A cardiologist in Florida who allegedly billed Medicare and Medicaid for medically unnecessary procedures has agreed to pay $6.75 million to resolve claims under the False Claims Act. Between 2013 and 2019, Dr. Ashish Pal allegedly made misrepresentations in patient medical records to justify ablations and vein stent procedures that were not reimbursable under program rules. Additionally, some of the procedures were later found to have been performed primarily by unqualified ultrasound technicians. As part of the settlement, Pal and Interventional Cardiology & Vascular Consultants, PLC, will enter in a multiyear integrity agreement and comply with training and reporting requirements, as well as a quarterly claims review by an independent organization. USAO MDFLConstantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference
Posted 09/10/21
DOJ Reasserts the Proper Role for Agency Guidance in Fraud Cases
Posted 09/3/21
August 25, 2021
A California-based provider of home respiratory services and durable medical equipment has agreed to pay $3.3 million to the United States and States of California and Nevada to settle allegations of defrauding Medicare and Medicaid. The claims against SuperCare Health, Inc. were brought in a 2018 qui tam suit by respiratory therapist Benjamin Martinez, who alleged that the provider billed for non-invasive ventilators (NIVs) that were no longer needed or being used by patients. CA AG; USAO CDCACatch of the Week: Telemedicine Company Owner Charged in $784 Million Kickback Scheme
Posted 08/20/21
Court says that fraudsters who violate rules they later claim are unclear may not violate the False Claims Act
Posted 08/19/21
