Medicare

November 7, 2017

Detroit-area doctor Johnny Trotter was sentenced to 180 months in prison and to pay roughly $9 million in restitution for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided and efforts to circumvent Medicare’s investigation of the fraudulent scheme.  DOJ

Freedom Health/Optimum - Healthcare Fraud/Medicare Advantage ($32.5 million)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Freedom Health and Optimum Healthcare inflated their Medicare Advantage patient risk scores to secure artificially high Medicare reimbursement.  In May 2017, the companies agreed to pay $32.5 million to settle the matter.  Our client received a whistleblower award of roughly $6.4 million.  Read more -- NPR, Miami Herald, DOJ, CC.

August 2, 2017

Atlanta-based pain management clinic Atlanta Medical Clinic and its owner Dr. Timothy Dembowski agreed to pay $250,000 to resolve charges they violated the False Claims Act by billing for services performed by a physician suspended from the Medicare program and administering foreign, non-FDA approved drugs, which are not eligible for reimbursement under the Medicare program.  DOJ (NDGA)

July 24, 2017

Dr. James Norman, the owner and operator of Norman Parathyroid Center, agreed to pay $4 million to resolve allegations he violated the False Claims Act by billing Medicare for pre-operative examination services for which he had already received payment from the government.  These extra fees ranged from $150 to $750 for Florida residents, to $1,750 or more for patients who lived out-of-state, adding up to hundreds of thousands of dollars in illicit billing.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former patient of Dr. Norman, Myra Gross, and her husband, Dr. David Gross.  They will receive a whistleblower award of roughly $600,000 from the proceeds of the government's recovery.  DOJ (MDFL)

July 24, 2017

Tennessee-based Pain Management Group P.C. agreed to pay $312,000 to settle charges it violated the False Claims Act by billing for medically unnecessary urine drug tests and non-FDA approved pharmaceuticals Botox, Supartz, and Eufflexa, which the company purchased from foreign-based suppliers.  DOJ (MDTN)

July 14, 2017

Rodney Hesson and Gertrude Parker, owners of Nursing Home Psychological Services and Psychological Care Services, were respectively sentenced to 180 months and 84 months in prison and to respectively pay $13.8 million and $7.3 million in restitution for their involvement in a $25.2 million Medicare fraud scheme involving billing Medicare for psychological testing services that nursing home residents did not need or in some instances did not receive.  DOJ

July 14, 2017

Narco Freedom, Inc., a former operator of outpatient chemical dependency clinics, Joining Hands Management Inc., an operator of short-term residences known as “three-quarter houses,” and Joining Hands co-owner Devorah Haigler, settled claims of violating the False Claims Act.  The government will receive a $50.5 million allowed claim in the Narco Freedom bankruptcy proceeding, and Joining Hands and Haigler will pay $300,000.  The government alleged the defendants engaged in a kickback scheme whereby Narco made monthly cash payments to Joining Hands in exchange for Haigler and others referring residents of Joining Hands three-quarter houses to NARCO outpatient programs.  The allegations originated in a whistleblower lawsuit under the qui tam provisions of the False Claims Act.  An unidentified whistleblower will receive an undisclosed whistleblower award from the proceeds of the government's recovery.  DOJ (SDNY)