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This archive displays posts tagged as relevant to Medicare and fraud in the Medicare program. You may also be interested in our pages:

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April 10, 2020

To settle fraud allegations by four relators in three qui tam suits, Michigan-based Encore Rehabilitation Services LLC has agreed to pay $4 million to the United States.  According to Linda Anderson, Reza Saffarian and Audrey Theile, and Adam LaFerriere, from roughly 2010 to 2018, the owner and operator of over 600 healthcare facilities allegedly caused three of its skilled nursing facilities to submit false claims to Medicare for services that were not medically necessary, reasonable, or provided by skilled therapists, and improperly billed group therapy sessions as if they were individual therapy sessions.  DOJ; USAO EDMI; USAO WDMI

April 6, 2020

Following a $7.1 million settlement with seven co-defendants in October 2019, a chiropractor in New Jersey who allegedly concocted the scheme to bill Medicare for medically unnecessary injections and knee braces has agreed to pay $2 million to resolve his liability.  A critical analysis of Medicare claims data revealed that while treating for osteoarthritis, David Podell caused his clinic and seven Osteo Relief Institutes to bill Medicare for viscosupplementation injections—gel-like fluids injected into the knee that act as lubricant—as well as custom knee braces for beneficiaries who did not need them.  Additionally, the claims for the custom knee braces were tainted by illegal kickbacks that Podell solicited and received from the manufacturer.  DOJ; USAO MN

New Lawsuit Against Anthem Shows the Government’s Commitment to Medicare Advantage Fraud

Posted  04/3/20
health insurance with stethoscope and hundred dollar bills
Medicare Advantage, also called Medicare Part C, is ever-expanding part of our healthcare system. The program now insures over a third of total Medicare beneficiaries, well over 10 million people. An expansion in fraud has accompanied the program’s expansion, and the Department of Justice is zeroing in, with the Assistant Attorney General for the Civil Division, Joseph Hunt, recently declaring it a...

April 2, 2020

FPR Specialty Pharmacy LLC and Mead Square Pharmacy, Inc., along with owners Christopher Casey and William Rue, have agreed to pay $426,000 to settle a whistleblower-brought case alleging violations of the Anti-Kickback Statute and False Claims Act in connection with a compounded prescription analgesic cream called Focused Pain Relief.  As part of the settlement, the defendants admitted that from 2011 to 2015, they sold prescription drugs to patients in states they were not licensed to sell in, failed to charge mandatory co-pays to beneficiaries of various federal healthcare programs, and paid sales agents to solicit physicians to prescribe the cream.  USAO SDNY

April 1, 2020

A physician’s assistant in Louisiana, Stephen Honeycutt, has agreed to pay $620,500 for accepting illegal kickbacks from OK Compounding, LLC, which has been involved in multiple enforcement actions of a similar nature across the country.  Over a period of about six months in 2013, Honeycutt prescribed expensive compounded pain creams to patients, many of whom were Medicare and TRICARE beneficiaries, in exchange for kickbacks disguised as medical director fees.  USAO NDOK

March 20, 2020

A doctor in Florida has paid the United States $850,000 to settle claims of violating the Anti-Kickback and False Claims Acts.  In exchange for prescribing a powerful but highly addictive fentanyl spray, Subsys, to her patients, Dr. Parveen Khanna allegedly took illegal kickbacks from manufacturer Insys Pharmaceuticals, Inc that were disguised as speaker fees, then submitted claims for reimbursement to Medicare and TRICARE in violation of program rules prohibiting payment for kickback-induced services.  USAO MDFL

March 13, 2020

Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, LLC, have agreed to pay $1.74 million to settle claims of submitting false and inflated claims to Medicare.  From 2011 to 2016, defendants billed and caused Medicare to pay for lower-level wound repairs as if they were more complex adjacent tissue transfers.  The misconduct was eventually exposed by whistleblowers Dr. Robert Green and Emily Kennedy, who will share in a $305,000 award.  USAO MDFL

March 11, 2020

Millennium Physicians Association PLLC, d/b/a Millennium Respiratory & Sleep Disorder Specialists, has agreed to pay $1.2 million to resolve whistleblower-brought allegations of fraud in connection with two sleep centers in Texas.  From 2015 to 2019, Millennium allegedly violated Medicare rules and the False Claims Act by improperly billing Medicare for sleep studies conducted without the presence of properly credentialed technicians.  As part of the settlement, the anonymous relator will receive a $187,344  share of the settlement.  USAO SDTX

“Objective Falsity” Is Not Required Under the False Claims Act: A Legally False Opinion May Suffice

Posted  03/6/20
Gavel close-up
In a significant win for whistleblowers, a federal appellate court held this week that, in order to determine liability under the False Claims Act, a whistleblower need not prove that a claim is “objectively” false.  Instead, the Court held that, consistent with common law, a claim can be false under the FCA if based not on objectively verifiable facts, but on non-compliance with statutory or regulatory...

March 4, 2020

STG Healthcare of Atlanta, Inc. and senior executives Paschal Gilley and Mathew Gilley have agreed to resolve fraud allegations by paying $1.75 million.  The case against the hospice was launched by two former employees, Serita Samuel and Miranda Eskridge, who alleged in a qui tam suit that STG Healthcare submitted false claims to Medicare and Medicaid that arose from illegal payments to so-called back-up medical directors, and that were on behalf of patients who were not terminally ill and thus ineligible for palliative care.  GA AG; USAO NDGA
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