Medicare
This archive displays posts tagged as relevant to Medicare and fraud in the Medicare program. You may also be interested in our pages:
July 13, 2020
Longwood Management Company and 27 affiliated skilled nursing facilities have agreed to pay $16.7 million to resolve allegations raised by whistleblowers Judy Boyce, Benjamin Monsod, and Keith Pennetti in two separate qui tam filings, that six Longwood facilities knowingly submitted false claims to Medicare. Between 2018 to 2012, Longwood allegedly pressured its rehabilitation therapists to increase the amount of therapy provided to Medicare Part A patients, regardless of medical necessity, so it could claim Ultra High levels of service, which are reimbursed at the highest rate. As part of the settlement, Longwood will enter into a five-year Corporate Integrity Agreement, and Boyce, Monsod, and Pennetti will share a $3 million award. DOJ; USDC CDCAJuly 10, 2020
Universal Health Services, Inc. and UHS of Delaware, Inc. (collectively, UHS), and a Georgia-based UHS facility, Turning Point Care Center, LLC, have agreed to pay a combined $122 million to settle 18 qui tam cases pending in four jurisdictions. In violation of the False Claims Act, UHS allegedly billed federal healthcare programs—including Medicare, Medicaid, TRICARE, the Department of Veteran Affairs, and the Federal Employee Health Benefit programs—for medically unnecessary inpatient behavioral health services, failed to provide adequate or appropriate services, and paid illegal inducements to beneficiaries of those programs. UHS will pay over $88 million to the federal government and nearly $29 million to individual states, for a combined penalty of $117 million, with a relator share of about $15.8 million. Turning Point will pay $5 million to the federal government and the State of Georgia; the whistleblower in that case will receive $861,853.64. USAO MDFL; USAO NDGA; USAO EDPA; AG FL; AG MI; AG NC; AG VAJuly 8, 2020
A Florida-based nonprofit that provides hospice care, palliative care, and other services to the elderly, has agreed to pay $3.2 million to resolve its liability under the False Claims Act. According to former Director of Hospice Care, Margaret Peters, Hope Hospice knowingly submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary but highly reimbursed general inpatient (GIP) hospice services over a five year period. For blowing the whistle on the alleged fraud, Peters will receive a 19% share of the settlement. USAO MDFLJuly 8, 2020
An orthopedic hospital, its management company, a physician’s group, and two physicians have agreed to pay $72.3 million to resolve whistleblower-brought allegations under the Anti-Kickback Statute, federal False Claims Act, and Oklahoma Medicaid False Claims Act of defrauding Medicare, Medicaid, and TRICARE. Between 2006 and 2018, the Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM) and its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), allegedly provided free or below-fair market rate services and compensation to Southwest Orthopaedic Specialists, PLLC (SOS), including SOS physicians Anthony Cruse, D.O., and R.J. Langerman, Jr., D.O., in exchange for patient referrals. USP also allegedly offered preferential investment opportunities to physicians in Texas. As part of the settlement, USP will pay $60.86 million to the United States, $5 million to the State of Oklahoma, and $206,000 to the State of Texas, while SOS and its physician defendants will pay $5.7 million to the United States and $495,619 to the State of Oklahoma. DOJJuly 7, 2020
Florida Cancer Specialists & Research Institute, LLC (FCS) has agreed to return more than $2.3 million in overcharges to the VA after a successful qui tam action by a former Claims Resolution Specialist with FCS, Marianne Parker. Parker’s complaint instigated a government investigation that found that an error in the VA’s billing system had led the agency to pay the full amount billed by FCS for certain physician-administered drugs provided to veterans, rather than at the Medicare rate mandated by the Code of Federal Regulations. For alerting the government to the discrepancies, Parker will receive a 20% share of the funds. USAO MDFLRegeneron: The Government’s Latest Stand against Patient Kickbacks
Posted 06/25/20
June 25, 2020
Georgia-based Piedmont Healthcare, Inc. has agreed to pay $16 million to resolve whistleblower-brought allegations that it violated the Anti-Kickback Statute and False Claims Act. The relator in this case, a former Piedmont physician, alleged that between 2009 and 2013, Piedmont’s case managers overturned physician recommendations for outpatient care by submitting claims for more expensive inpatient care to Medicare and Medicaid. Furthermore, when the healthcare system acquired the Atlanta Cardiology Group in 2007, it allegedly paid far above fair market value for a catherization lab that was partly owned by the practice group. For bringing a successful enforcement action, the unnamed relator will receive a share of nearly $3 million of the settlement proceeds. USAO SDGAJune 24, 2020
Augusta University Medical Center (AUMC) has agreed to pay $2.6 million to resolve fraud allegations by the United States, State of Georgia, and State of South Carolina under state and federal False Claims Acts. According to the government, AUMC knowingly submitted claims to Medicare and Medicaid for a medically unnecessary procedure that was billed as a covered procedure. USAO SDGAMedicare Risk Adjustment Fraud is Not Victimless
Posted 06/18/20
