Medicare
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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
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 AZMay 4, 2021
Alberto Orian Gonzalez-Delgado was sentenced to 210 months in prison after pleading guilty to conspiracy to commit health care fraud and wire fraud. He is the last of eight individuals to be sentenced for a money laundering scheme in Florida and Michigan involving the use of nominee owners to fraudulently purchase home health agencies and then bill Medicare for services that were never provided to Medicare beneficiaries. The defendants caused the payment of approximately $53 million in fraudulent claims. DOJMay 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 EDPAMay 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 SDTXApril 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 NDALApril 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 MDTNApril 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 MACatch of the Week: Telemarketer Gets 10 Years in $3.3 Million Telemedicine and Genetic Testing Fraud Scheme
Posted 04/16/21
