Medicare

October 19, 2016

Elaine Davis and Pramela Ganji, the owner and medical director of New Orleans medical service company Christian Home Health Inc., were respectively sentenced to 96 months and 72 months in prison for their involvement in a $34 million Medicare fraud scheme.  According to evidence introduced at trial, Davis directed a massive fraud scheme through her company, using elderly and disabled Medicare recipients in New Orleans and adjacent communities to fraudulently bill Medicare for home health care services these patients did not require.  DOJ

October 7, 2016

Pilar Garcia Lorenzo, the owner of Tampa home health care agency Gold Care Home Health Services Inc., was convicted for her participation in a multimillion-dollar health care fraud and money laundering scheme.  According to evidence presented at trial, Gold Care submitted millions of dollars’ worth of false and fraudulent claims to Medicare for home health services that had never been provided and had not been legitimately prescribed by a physician resulting in $2.5 million in improper Medicare reimbursements.  DOJ

Bay Sleep Clinic - Healthcare Fraud/Kickbacks ($2.6 million)

Constantine Cannon represented a whistleblower under the False Claims Act case alleging Bay Sleep Clinic billed Medicare for sleep studies by unlicensed technicians and paid kickbacks to doctors for patient referrals.  In December 2016, the company agreed to pay $2.6 million to settle the matter.  Our client received a whistleblower award of roughly 21% of the government’s recovery.  Read more -- SF Gate, DOJ, PR Newswire, CC.

September 7, 2016

Medical equipment supply companies U.S. Healthcare Supply LLC and Oxford Diabetic Supply Inc., along with their owners and presidents, agreed to pay more than $12.2 million to resolve allegations that they violated the False Claims Act by making unsolicited calls to Medicare beneficiaries to sell them durable medical equipment.  According to the government, the two companies created a fictitious company called Diabetic Experts Inc., which they used to make the unsolicited calls, and then submitted claims to Medicare for the equipment they sold in violation of the Medicare Anti-Solicitation Statute.  Whistleblower Insider

August 31, 2016

Clear Vue Eye Center and its owner, Dr. Monique Barbour, agreed to pay $1 million to resolve allegations that they violated the False Claims Act by overbilling Medicare for patient visits at nursing homes and assisted living facilities, and for billing for procedures purportedly performed while Dr. Barbour was out of the country.  According to the government, Dr. Barbour billed excessively for patient visits, billing for more than 12 hours a day and often for more than 20 hours in a 24-hour period.  Records reviews show that many of the procedures billed were medically unnecessary with little patient benefit and that Dr. Barbour billed procedures at the most profitable rates regardless of the procedure’s proper billing code.  The allegations originated in a whistleblower lawsuit brought by former Clear Vue employee Lori Moore under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $200,000 from the proceeds of the government's recovery.  DOJ (SDFL)