Medicare

May 1, 2017

Kansas City area chiropractor Brian Schnitta and his clinic, Natural Way Chiropractic Center, agreed to pay roughly $1 million to settle allegations they violated the False Claims Act by charging Medicare for treatments for peripheral neuropathy not medically necessary or not otherwise covered by the program. DOJ (DKS)

April 25, 2017

Braden Partners, L.P. (d/b/a Pacific Pulmonary Services) agreed to pay $11.4 million to resolve allegations against it and its general partner, Teijin Pharma USA LLC, for violating the False Claims Act by submitting claims for reimbursement to Medicare and other federal healthcare programs for oxygen and related equipment supplied in violation of program rules, and for sleep therapy equipment supplied as part of a cross-referral kickback scheme with sleep clinics. According to the government, Pacific Pulmonary submitted claims to the Medicare, TRICARE and Federal Employee Health Benefits programs for home oxygen and oxygen equipment without obtaining the required physician authorization. The government further charged that certain of the company’s patient care coordinators agreed to make patient referrals to sleep testing clinics in exchange for those clinics’ agreement to refer patients to Pacific Pulmonary for sleep therapy equipment in violation of the Anti-Kickback Act. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Manuel Alcaine, a former sales representative of Pacific Pulmonary. Mr. Alcaine will receive a whistleblower award of roughly $1.8 million from the proceeds of the government's recovery. DOJ

March 22, 2017

DOJ discloses that it is investigating health insurance company Humana Inc., a defendant in Constantine Cannon’s whistleblower lawsuit alleging Medicare risk adjustment fraud.  Click here to read more.

March 13, 2017

Massachusetts-based Charles River Laboratories International Inc. agreed to pay $1.8 million to settle claims it violated the False Claims Act by improperly charging for labor and other associated costs not actually provided on certain National Institutes of Health contracts relating to the provision of laboratory animals to the NIH. DOJ

March 6, 2017

Simon Hong, owner of Los Angeles-based JH Physical Therapy Inc., was sentenced to 63 months in prison and to pay roughly $2.4 million in restitution, for his role in a $3.4 million Medicare fraud scheme that involved billing for occupational therapy services that were not medically necessary and not provided.   Hong admitted billing Medicare for occupational therapy services when what were provided instead were acupuncture and massage services, not reimbursable by Medicare.  Hong further admitted directing co-conspirator therapists to falsify medical records to make it appear as if the services billed actually had been provided. DOJ

March 3, 2017

Rex Duruji, an unlicensed medical professional posing as a physician, was convicted for his participation in a $1.3 million Medicare fraud scheme.  The evidence presented at trial showed that Duruji posed as a physician to induce Medicare beneficiaries to sign up for fraudulent home-health services with Koby Home Health that were not actually provided and paid illegal cash kickbacks to the beneficiaries for those claims. DOJ

March 2, 2017

Detroit-area physician Aaron Goldfein pleaded guilty for his role in a $5.4 million Medicare fraud scheme involving phony physician visits and drug prescriptions.  As part of his plea, Goldfein admitted to being part of a scheme in which his co-conspirators would hold themselves out as licensed physicians and purport to perform physician home visits and other services for Medicare beneficiaries, although these co-conspirators were not licensed to practice medicine in Michigan.  Goldfein would then bill Medicare through Tri-City Medical Center as if he himself had completed these visits.  Goldfein also admitted to being part of a scheme in which he received kickbacks in exchange for writing home health prescriptions. DOJ

March 16, 2017

Northern California Record discusses Constantine Cannon’s matter against Bay Sleep Clinic.  Click here to read its article: Government settles $2.6 M whistleblower suit against sleep clinics.

March 2, 2017

New York announced the sentencing of two pharmacy owners, a supervising pharmacist and ten corporations for defrauding several government-funded healthcare programs, including Medicaid and Medicare. An investigation revealed that on at least eight separate occasions between November 2013 and February 2014, the defendants paid patients hundreds of dollars in cash to forgo their prescription medications, the vast majority of which were to treat HIV. The defendants then submitted false claims to Medicare, Medicaid and Medicaid-managed care organizations and were reimbursed for distributing the medications, despite the fact that they were never dispensed to patients. Tarek Elsayed, 50, of Elmhurst Queens, the co-owner of 184th Street Pharmacy in the Bronx, was sentenced in Bronx County Supreme Court by the Honorable Stephen Barrett to one to three years in state prison. Previously, in August of 2016, Ahmed Hamed, 39, of Elmhurst Queens, the second co-owner of 184th Street Pharmacy, was sentenced to two to six years in state prison. In October of 2016, Mohamed Hassan Ahmed, 38, of Bayside, the supervising pharmacist at 184th Street Pharmacy, was sentenced to one to three years in state prison and was required to surrender his license to practice pharmacy. Collectively, the three defendants stole over $10 million from government-funded health care programs. In addition, the Attorney General’s Medicaid Fraud Control Unit (MFCU) reached a $4.1 million civil settlement agreement with defendant Elsayed and a $3.8 million civil settlement agreement with defendant Hamed. NY