Medicare
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January 19, 2021
Texas-based Allstate Hospice LLC and Verge Home Care LLC and their founders, Onder Ari and Sedat Necipoglu, have paid over $1.8 million to resolve allegations of submitting claims to Medicare that were tainted by improper inducements. In violation of the Physician Self-Referral Law and False Claims Act, the defendants allegedly set up monthly payments to referring physicians through sham medical directorship agreements, sold interests to five referring physicians in order to provide them with substantial quarterly dividends, and provided other referring physicians with free tickets and travel. USAO SDTXJanuary 6, 2021
Exceltox, a genetic testing laboratory in California, has agreed to pay $357,584 to resolve allegations of submitting false claims to Medicare over two months in 2015. With the help of a New Jersey-based contractor named Seth Rehfuss, Exceltox allegedly performed genetic tests on seniors in New Jersey-based senior housing complexes without proper orders from a treating physician, then submitted claims to Medicare for these tests. For his role in the fraud, Rehfuss was sentenced to over 4 years in prison in 2019. USAO NJTop Ten Healthcare Fraud Recoveries of 2020
Posted 01/5/21
January 4, 2021
Three providers, James P. Anderson, as owner of Affiliated Neurologists, PLC; Charles F. Spencer, as owner of Total Family Physicians Center PLLC; and Mitchell P. Shea, as owner of Chiro2Med of Tennessee P.C., have agreed to pay the United States and Tennessee a total of $1.72 million to resolve allegations under the False Claims Act for improperly billing Medicare and TennCare for “P-Stim” electro-acupuncture devices that do not qualify for reimbursement. The defendants billed for the disposable P-Stim devices using a code reserved for neurostimulator devices that are implanted during a surgical procedure. USAO MDTNNovember 24, 2020
Florida-based Doctor’s Choice Home Care, Inc. and its founders and former top executives Timothy Beach and Stuart Christensen have agreed to pay a combined $5.15 million to settle qui tam suits filed under the False Claims Act by former employees—one by Corina Herbold, and the other by Sara Billings, Misty Sykes, and Marina Eschoyez-Quiroga. In violation of the Anti-Kickback Statute and the Stark Law, the home health agency had allegedly set up sham medical director agreements with physicians to pay them for referrals, linked employee bonuses to referrals made by physician spouses, and provided medically unnecessary services to Medicare patients in order to avoid decreased reimbursements triggered by fewer than five skilled service visits. To settle the allegations, Doctor’s Choice will pay over $4.5 million, while Beach and Christensen will pay $647,000 each. Billings, Sykes, and Eschoyez-Quiroga will jointly receive $145,000 of the settlement proceeds; Herbold’s share has yet to be determined. DOJ; USAO MDFLNovember 20, 2020
Mori, Bean and Brookes, P.A. (MBB), a Florida-based radiology practice, has agreed to pay $1.4 million to resolve allegations of violating the False Claims Act. In a qui tam suit by Thomas Heyck, a radiologist formerly employed at MBB, the practice improperly billed Medicare and Medicaid for radiological images that were interpreted outside the U.S., which are not eligible for reimbursement. MBB also submitted claims for images that were initially interpreted overseas, then reinterpreted and billed to a domestic radiologist. For blowing the whistle, Heyck will receive a 19% relator’s share. USAO MDFLConstantine Cannon settles with one defendant in case alleging bilking of the Medicare Advantage program. Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative) will pay $6.375M.
Posted 11/17/20
