Medicare
This archive displays posts tagged as relevant to Medicare and fraud in the Medicare program. You may also be interested in our pages:
March 2, 2020
The owners and operators of Middlesex Rheumatology in Connecticut, Dr. Crispin Abarientos and his wife Dr. Antonieta Abarientos, have agreed to pay $4.9 million to settle allegations of violating federal and state False Claims Act. Between 2013 to 2017, the Abarientos allegedly billed Medicaid for an injectable prescription drug called Remicade, which is used to treat rheumatoid arthritis, but then failed to administer the drugs on Medicaid patients. Instead, they administered them on patients covered by Medicare or the Connecticut State Employees Health Plan, then billed the two providers for the drugs again even though the cost had already been covered by Medicaid. USAO CTFebruary 28, 2020
Nursing home chain Diversicare Health Services, Inc. has agreed to pay $9.5 million to resolve whistleblower-brought allegations of submitting claims to Medicare and Medicaid for medically unnecessary rehabilitation therapy services. According to separate qui tam complaints by former employees, Mary Haggard and Bryant Fitzmorris, between 2010 to 2015, Diversicare unnecessarily placed beneficiaries in the highest category of reimbursement in order to receive higher payouts, and submitted forged pre-admission evaluation certifications to Medicaid. As part of the settlement, Diversicare has entered into a Corporate Integrity Agreement for five years, Haggard will receive approximately $1.4 million, and Fitzmorris will receive approximately $145,450. DOJ; USAO MDTNFebruary 28, 2020
Sanofi-Aventis U.S., LLC has agreed to pay $11.85 million to resolve allegations of paying kickbacks to Medicare patients in connection with a multiple sclerosis drug called Lemtrada. According to the press release, Lemtrada costs nearly $100,000 per patient per year, and Medicare co-pays can be many thousands of dollars per year. In order to break down barriers to access for Medicare patients, Sanofi allegedly provided kickbacks to them via payments to a purportedly independent charitable foundation, The Assistance Fund (TAF), which helps covers the co-pays in violation of the Anti-Kickback Statute. The scheme was reported by a partnership formed by Sanofi's predecessor, Genzyme Corporation, which will receive about $2.7 million for their role in the case. USAO MAFebruary 26, 2020
The two owners and operators of Royal Care Pharmacy in Los Angeles have been ordered to pay restitution of $11.8 million to Medicare and $17,000 to Cigna after being found guilty of healthcare fraud and money laundering. Aleksandr Suri and Maxim Sverdlov were also sentenced to 12 years in prison. From 2012 to 2015, the two had fraudulently billed Medicare and Cigna for prescription medications that were not purchased or dispensed to beneficiaries, hiding the conspiracy and laundering the proceeds through fake invoices. DOJTreble Damages Awarded in Medicare Whistleblower Case
Posted 02/21/20
February 19, 2020
Guardian Elder Care Holdings, Inc. has agreed to pay $15.5 million to settle claims of defrauding Medicare and Medicaid. In a qui tam suit filed in 2015, whistleblowers Philippa Krauss and Julie White alleged that from 2011 to 2017, the Pennsylvania-based nursing home chain pressured its therapists to provide medically unnecessary rehabilitation to patients suffering from dementia or dying in hospice care in order to boost its profits. During the subsequent government investigation, Guardian Elder Care self-disclosed that it had also billed federal healthcare programs for services performed by two excluded individuals. As part of the settlement, Guardian Elder Care has entered into a chain-wide Corporate Integrity Agreement with the Department of Health and Human Services, and Krauss and White will split a $2.8 million relator's share. USAO EDPA; USAO WDPACatch of the Week: Colorado Neurosurgeon and His Three Companies Settle Spinal Implant Kickback Claims for $2.35M
Posted 02/14/20
