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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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July 13, 2022

Solera Specialty Pharmacy and its CEO, Nicholas Saraniti, has agreed to pay $1.31 million and enter into a three-year integrity agreement to resolve allegations of defrauding Medicare.  Solera allegedly submitted fraudulent claims for Evzio—a high-priced version of naloxone, which reverses opioid overdoses—based on prior authorization requests that contained false clinical information, that were not actually approved by physicians, and that improperly listed Solera’s contact information as if it were the physician’s.  In connection with a criminal information, Solera has also entered into a deferred prosecution agreement.  The whistleblower in this case, a former employee of Evzio manufacturer kaléo Inc. named Rebecca Socol, will receive a $262,000 share of the settlement.  DOJ

July 7, 2022

A hospital in West Virginia, Weirton Medical Center, has agreed to pay $1.5 million to settle allegations of submitting or causing to be submitted claims to Medicare that resulted from an improper financial relationship.  In violation of the Stark Law, Weirton allegedly paid referring physicians compensation based on volume and that exceeded fair market value.  USAO NDWV

July 1, 2022

MCS Advantage, Inc. has agreed to pay $4.2 million in order to resolve allegations of submitted or causing to be submitted false claims to Medicare.  In violation of the Anti-Kickback Statute and False Claims Act, MCS allegedly distributed 1,703 gift cards totaling $42,575 to administrative assistants working under healthcare providers in order to induce referrals of Medicare beneficiaries to its plan.  USAO PR

June 29, 2022

Citadel Care Centers LLC and Plaza Rehab and Nursing Center will pay $7.85 million for switching their elderly residents’ Medicare coverage to maximize the Medicare payments the centers would receive--a blatant False Claims Act violation. Citadel directed Plaza employees to disenroll residents from Medicare Advantage Plans and enroll them in Original Medicare instead—without the residents’ knowledge or consent—to maximize their reimbursements. USAO SDNY

A recent case could undermine the rules that have been protecting taxpayer money from fraud since the time of Lincoln

Abraham Lincoln Statute
Constantine Cannon whistleblower lawyers Eric Havian, Mike Ronickher, and Ari Yampolsky were published in Fortune.com on the Supreme Court's consideration of the SuperValu decision.
We’re whistleblower lawyers who spend our careers speaking in legalese. But every once in a while, a case comes along that is so alarming, yet so couched in jargon, that an issue of great importance can easily escape notice. When that...

June 16, 2022

A Florida man who was convicted of defrauding Medicare of over $20 million and evading taxes has been sentenced to 14 years in prison and ordered to pay $4 million in restitution to the IRS.  As the owner and operator of multiple telemarking and telemedicine companies, Marc Sporn marketed and sold signed prescription orders for medically unnecessary genetic tests, in exchange for illegal kickbacks from pharmacies and laboratories.  USAO SDFL

June 10, 2022

A doctor who allegedly submitted claims to Medicare and Medi-Cal for unperformed procedures, services, and tests, in violation of the California and federal False Claims Acts, has agreed to pay $9.5 million to resolve a civil suit.  The qui tam case by Minas Kochumian’s former medical assistant Elize Oganesyan, and former IT consultant Damon Davies, alleged that claims for treatment of osteopathic issues that were submitted over a six year period were false.  The settlement includes $5.5 million that Kochumian already paid as criminal restitution in a separate case in the Central District.  As part of the civil settlement, Oganesyan and Davies will share a $1.75 million award.  CA AG; USAO EDCA

June 6, 2022

SNAP Diagnostics LLC, along with its founder, Gil Raviv, and vice president, Stephen Burton, will pay a combined $3.925 million to settle allegations of False Claims Act and Anti-Kickback Statute violations. SNAP routinely submitted claims for Medicare and TRICARE patients’ second and third nights of home sleep testing, when patients with private health insurance were routinely billed only for the first night. Additionally, SNAP multiplied copays from senior citizen Medicare beneficiaries, and incentivized physicians to refer their patients for sleep testing services. USAO NDIL

June 3, 2022

Rodney L. Yentzer will pay $900,000 for violating the False Claims Act. Through Pain Medicine of York, a group of clinics he controlled, Yentzer caused the submission of false claims for payment to Medicare for urine drug tests that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. He is excluded from participation in all federal health care programs for 22 years. In March of 2022, Yentzer pleaded guilty to Health Care Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the U.S. Department of Health and Human Services between 2016 and 2020. USAO MDPA

May 24, 2022

Dr. Roger Wang will pay over $1 million for violations of the False Claims Act committed by charging Medicare for non-FDA-approved drugs and associated services. Dr. Wang, a rheumatology specialist, injected his patients with drugs like Synvisc, Synvisc One, or Orthovisc—vicosupplements used to treat osteoarthritis pain—that were not FDA-approved for distribution in the US, and therefore not billable to Medicare. USAO NDCA
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