Medicare
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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 SDNYMarch 26, 2021
Following two whistleblower complaints, a former owner of a now-defunct diagnostic testing laboratory in North Carolina and South Carolina has agreed to pay $2 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act. Together with other agents of Physicians Choice Laboratory Services (PCLS), Phillip McHugh allegedly offered and provided benefits to physicians in exchange for referrals of patient samples, causing false claims to be submitted to Medicare. A second defendant in the case, former sales representative and manager Manoj Kumar, has already paid approximately $650,000 to resolve similar claims. USAO WDNCMarch 24, 2021
Two men in Mississippi have been sentenced to 7 years in prison and ordered to pay over $16 million in restitution to Medicare, TRICARE, and Express Scripts, as well as forfeiture of close to $1 million, for their roles in a multimillion-dollar healthcare fraud scheme. Dempsey Bryan Levi and Jeffrey Wayne Rollins, the operators of the Gardens Pharmacy, LLC, had previously admitted to soliciting and incentivizing recruiters to obtain prescriptions for highly reimbursed compounded medications, and soliciting and incentivizing doctors to authorize those prescriptions. USAO SDMSMarch 18, 2021
A Michigan-based cardiologist, Dinesh Shah, and his practice, Michigan Physicians Group, P.C. (MPG), have agreed to pay $2 million to resolve allegations of defrauding Medicare, Medicaid, and TRICARE by submitting claims for medically unnecessary diagnostic testing, in violation of the False Claims Act. In separate qui tam suits filed by former employees Arlene Klinke and Khrystyna Mala, the whistleblowers alleged that between 2006 and 2017, Shah and MPG billed government healthcare programs for Ankle Brachial Index tests, Toe Brachial Index tests, and Nuclear Stress Tests that were ordered and provided without regard to necessity. USAO EDMIMarch 8, 2021
Vascular surgeon Feng Qin and his medical practice Qin Medical P.C. will pay $800,000 to resolve civil claims and criminal charges that Qin performed procedures on end-stage renal disease patients that were not medically reasonable and necessary, and fraudulently billed Medicare. Qin performed vascular access procedures on patients on a routine scheduled basis, without documenting the required clinical findings. The government’s investigation was initiated by the filing of a qui tam complaint by Mark Favors. USAO SDNYMarch 5, 2021
A substance abuse treatment facility and two inpatient psychiatric hospitals in Ohio, along with their corporate parent, have agreed to pay $10.25 million to resolve claims under the Anti-Kickback Statute and False Claims Act. According to DOJ, between 2013 and 2019, The Woods at Parkside, Cambridge Behavioral Hospital, and Ridgeview Behavioral Hospital—all owned by Florida-based Oglethorpe Inc.—allegedly provided improper inducements in the form of free long-distance transportation in order to entice patients to seek treatment at their facilities, and then submitted claims for services provided to those patients to Medicare. The case was initiated by a former client advocate working at Cambridge, Darlene Baker. DOJ; USAO SDOHThe False Claims Act: It Benefits More than Just the Government
Posted 03/5/21
