Medicare

February 24, 2017

Raciel Leon, manager of Mercy Home Care Inc. and a billing employee for D&D&D Home Health Care Inc., two Miami-area home health agencies, was sentenced to a 126 month prison term for his role in a $2.5 million Medicare fraud scheme.  The evidence at trial showed that Leon and his co-conspirators used the companies to submit false claims to Medicare based on services not medically necessary, not actually provided, and for patients procured through the payment of illegal kickbacks to doctors and patient recruiters.  DOJ

February 16, 2017

New Jersey doctor Kenneth D. Nahmu, his wife Ann Walsh and their oncology practice agreed to pay $1.7 million to resolve allegations they violated the False Claims Act by billing Medicare for illegally importing and using unapproved chemotherapy drugs from foreign distributors.  DOJ (DNJ)

February 10, 2017

Dr. Paul B. Tartell, an ENT physician practicing in Plantation, Florida and his practice Paul B. Tartell, M.D., P.L., have agreed to pay $750,000 to resolve allegations that he violated the False Claims Act by billing for surgical endoscopies with debridement and laryngeal stroboscopies that were not provided or not medically necessary.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Theodore Duay, a former patient of Dr. Tartell.  Mr. Duay will receive a whistleblower award of $135,000 from the proceeds of the government's recovery.  DOJ (SDFL)

February 9, 2017

University Behavioral Health of El Paso agreed to pay $860,000 to resolve allegations it violated the False Claims Act by submitting false claims to Medicare tainted by the payment of kickbacks to a physician under the guise of a professional services agreement in return for the physician’s referral of patients to the hospital.  Specifically, the physician received payments above fair market value, or for services not rendered, and made improper referrals to the hospital for Medicare-reimbursed services.  DOJ (WDTX)

February 7, 2017

Florida physician Gary L. Marder, and the owner of the Allergy, Dermatology & Skin Cancer Centers in Port St. Lucie and Okeechobee, stipulated to a consent final judgment of over $18 million to settle False Claims Act allegations that Dr. Marder submitted claims to federal healthcare programs for medically unnecessary biopsies and radiation therapy services, radiation therapy services performed in contravention of standard practice regarding the amount of time between radiation treatments, and radiation therapy services performed without direct supervision and by unlicensed and/or unqualified physician assistants.  Dr. Kendall also allegedly submitted false claims to federal and state healthcare programs for laboratory services tainted by kickbacks to, and improper financial relationships with, Dr. Marder.  The allegations originated in a whistleblower lawsuit filed by Dr. Theodore A. Schiff under the qui tam provisions of the False Claims Act.  He will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (SDFL)

February 6, 2017

U.S. hospital service provider TeamHealth Holdings (as successor in interest to IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc.), agreed to pay $60 million to resolve allegations it violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed (a practice known as “up-coding”).  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist.  He will receive a whistleblower award of roughly $11.4 million.  DOJ

February 2, 2017

Pain management physician Dr. Robert Windsor, owner of National Pain Care, Inc. which owns pain management clinics in Georgia and Kentucky, agreed to the entry of a $20 million consent judgment to resolve allegations he violated the False Claims Act by billing federal health care programs for surgical monitoring services he did not perform and for medically unnecessary diagnostic tests.  The allegations originated in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act by Kris Frankenberg, Stephanie Herder and Bradley Davis.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government’s recovery.  Whistleblower Insider

February Roundup – February 17-20, 2017

Constantine Cannon attorneys quoted in articles about the DOJ joining its whistleblower lawsuit against UnitedHealth Group:

• UnitedHealth Filing Reflects DOJ’s Heightened Fraud Focus, Bloomberg BNA;
• Whistleblower suit alleges UnitedHealth defrauded Medicare, StarTribune;
• Justice Department joins Medicare Advantage fraud lawsuit against UnitedHealth, Modern Healthcare;
• Feds Join FCA Suit Targeting UnitedHealth Billing, Law360;
• United Healthcare Whistleblower Suit Provides ‘Interesting’ Investment Opportunity, The Street;
• Lawsuit says UnitedHealth tied to scheme to overbill Medicare, MINNPOST;
• DOJ joins whistle-blower suit accusing UnitedHealth of overbilling Medicare , Becker's Hospital Review;
• Justice Department joins lawsuit against UnitedHealth over Medicare billing, Minneapolis/St. Paul Business Journal;
• UnitedHealth Lower Off NYT Article Claiming Suit For Overbilling Medicare, Benzinga;
• UnitedHealth, Health Insurers Fall As DOJ Joins Whistleblower Suit, Investor's Business Daily;
• Feds join whistleblower suit that accuses UnitedHealth of inflating Medicare Advantage risk scores, Fierce Healthcare;
• United Health sinks after being sued by the US government (UNH), Business Insider;
• Feds join whistleblower lawsuit claiming UnitedHealth overcharged Medicare, TwinCities (Pioneer Press);
• UnitedHealth leads Dow losses after US joins whistleblower case, Financial Times;
• UnitedHealth shares fall after Justice Department joins Medicare whistleblower lawsuit, CNBC ;
•  UnitedHealth's Medicare business draws federal scrutiny, Minnesota Public Radio;
• DOJ joins whistleblower lawsuit against UnitedHealth Group, WellMed, Healthcare Finance News;
• Suit Says, Scheme Tied to UnitedHealth Overbilled Medicare for Years, Morning Outlook; and
• UnitedHealth Group Targeted by Whistleblower Lawsuit, Hamodia.