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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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Treble Damages Awarded in Medicare Whistleblower Case

Posted  02/21/20
specimen jar
The Fifth Circuit upheld a 2018 lower court decision this week, finding defendant BestCare Laboratory Services, LLC and its owner Karim Maghareh liable for treble damages—to the tune of just over $30 million—under the False Claims Act. BestCare provided clinical testing services for nursing home residents, many of whom were Medicare beneficiaries. Rather than billing for a technician’s travel to and from the...

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 WDPA

Catch of the Week — Colorado Neurosurgeon and His Three Companies Settle Spinal Implant Kickback Claims for $2.35M

Posted  02/14/20
skeleton of a spine
This edition of our Catch of the Week series features the successful resolution of a whistleblower suit against neurosurgeon Dr. William Choi and three companies he owned.  The defendants agreed to pay the United States $2.35 million to resolve allegations that, for over five years, Dr. Choi received illegal kickbacks from spinal implant device distributors for devices he used in surgeries. The kickbacks rendered...

February 14, 2020

Tennessee-based Cookeville Regional Medical Center Authority (CRMC) has agreed to pay $4.1 million to settle allegations of violating the Anti-Kickback Statute, Stark Law, and False Claims Act from 2012 to 2017.  In a qui tam suit that initiated the investigation, an unnamed whistleblower alleged that CRMC submitted claims to Medicare and TennCare that arose from improper financial arrangements with physicians at its wholly owned subsidiary, CRMC MSO-Sub 1, Inc., d/b/a Tennessee Heart.  $3.6 million of the settlement proceeds will go to the United States, $453,000 will go to the State of Tennessee, and $779,000 will go to the whistleblower.  USAO MDTN

February 12, 2020

A neurosurgeon accused of receiving illegal kickbacks from distributors of spinal implant devices has agreed to pay $2.35 million to resolve allegations of violating the Anti-Kickback Statute and False Claims Act.  While practicing at three Colorado area hospitals, Dr. William Choi created distributorships Nexus Spine, LLC and 4D Spine, LLC to provide spinal implant equipment for surgeries he performed.  Despite naming third parties as the registered owners, Dr. Choi maintained control of the distributorships and their profits, thus soliciting and receiving improper payments from these entities.  His fraudulent conduct was eventually revealed by a former 4D employee, Mark Rahe, who filed the civil action.  USAO CO

February 11, 2020

Tenet Healthcare Corporation and its affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.4 million to settle allegations that they knowingly charged Medicare for medically unnecessary cardiac monitors, in violation of the False Claims Act.  According to former DRMC employee, Michael Grace, the devices were implanted between 2014 to 2017, exposing beneficiaries to unnecessary risk and causing the government unnecessary expenses.  For exposing the fraud, Grace will receive a $240,789 share of the recovery.  DOJ

February 6, 2020

A patient recruiter in Kentucky has been sentenced to 5 years in prison and ordered to pay or forfeit over $1.2 million in total for accepting more than $1 million in kickbacks from home health agencies in exchange for providing information about Medicare beneficiaries.  The owner of Trumbo Consulting Agency in Virginia, Dominic Trumbo recruited and paid others to recruit over 4,000 Medicare beneficiaries for home health services by offering incentives to get them to sign up.  Trumbo then sold the information to home health agencies around the country in exchange for kickbacks, then created fake contracts and invoices to conceal the fraud from Medicare.  DOJ

February 4, 2020

Southeastern Retina Associates (SERA), which operates in parts of Tennessee, Georgia, and Virginia, has agreed to pay $1.5 million and enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services for allegedly defrauding Medicare and Medicaid.  The investigation was launched by a qui tam suit filed by an unnamed whistleblower, which alleged that between 2009 to 2016, the practice improperly billed exams at a higher rate than appropriate, and used a billing code called Modifier 25 to bill for exams that were not separately billable from other services billed the same day.  For exposing the misconduct, the relator in this case will receive a $270,000 share of the settlement.  USAO EDTN

Opioid Executive Sentenced to Over Five Years in Prison for Role in Healthcare Fraud Scheme

Posted  01/31/20
opioid pills scattered around
Insys Therapeutics, an opioid manufacturer whose main product is Subsys, a spray from of fentanyl that is 100 times stronger than morphine and cost tens of thousands a month, is in the news again. The company and its former CEO, John Kapoor, have been facing a mountain of legal issues in the past three years. Last week, in a decision that most of our readers agree with, Kapoor was sentenced to 66 months in prison. 

January 29, 2020

A Florida-based physician, Erik Schabert, and his ex-wife, Mika Harris, have been sentenced to 3.5 years and 3 months in prison, and ordered to pay almost $4.5 million in restitution to Blue Cross Blue Shield for attempting to defraud the insurer and the Medicare program of more than $8 million.  Between 2013 and 2016, the two owners and operators of Reliant Family Practice falsely diagnosed actinic keratosis and rosacea in order to make fraudulent claims for chemical peels and dermabrasions.  Along with prison time and restitution, the two have forfeited their private residence, commercial property, and over $260,000 in an annuity account, to the federal government.  USAO NDFL
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