Medicare

September 4, 2015

Rick Brown, former president of Home Care America Inc., which managed the daily business operations of Medicall Physicians Group Ltd., was sentenced to 87 months in prison and to pay $1.3  million in restitution for his role in a $4 million health care fraud scheme.  Medicall is a physician practice that visited patients in their homes and prescribed home health care.  The evidence at trial showed that Brown and his co-conspirators routinely billed Medicare for overseeing patient care plans when in fact the doctors at Medicall rarely did so.  The evidence also showed that Brown and his co-conspirators billed Medicare for services never provided, including services rendered to patients who were deceased, services purportedly provided by medical professionals no longer employed by Medicall, and services purportedly provided by medical professionals who, based on billing records, worked over 24 hours per day. DOJ

August 7, 2015

Tamara Esponda, owner of Miami-based Biomax Pharmacy, pleaded guilty to submitting almost $1.6 million in fraudulent claims to Medicare.  Specifically, Esponda admitted that Biomax Pharmacy submitted fraudulent claims to Medicare for prescription drugs not prescribed by physicians, not medically necessary, not purchased by Biomax Pharmacy and not provided to Medicare beneficiaries.  DOJ

June 1, 2015

A group of home health care companies collectively known as “Friendship” and the companies’ owner Theophilus Egbujor agreed to pay $6.5 million to resolve allegations they improperly billed TennCare, Medicare and TRICARE for home health services.  Specifically, the government claimed Friendship billed TennCare for private duty nursing services that were furnished or supervised by a woman who was excluded from billing federal and state health care programs and that Friendship submitted required forms to TennCare that contained the forged signature of Friendship’s Director of Nursing.  The specific entities included in the settlement agreement are Friendship Home Healthcare, Inc., which has also done business as Friendship HealthCare System; Friendship Home Health, Inc., and Angel Private Duty and Home Health, which have also done business as Friendship Private Duty; and Friendship Home Health Agency, LLC.  The allegations first arose in a whistleblower lawsuit filed by Kay Flippo, a licensed practical nurse who previously worked for Friendship Home Healthcare, under the qui tam provisions of the False Claims Act.  She will receive a yet-to-be determined whistleblower award. DOJ

December 18, 2015

Thirty-two hospitals in 15 states agreed to pay more than $28 million to settle charges they violated the False Claims Act by submitting false claims to Medicare for minimally-invasive kyphoplasty procedures used to treat certain spinal fractures often arising from osteoporosis.  According to the government, the settling hospitals billed Medicare for these procedures on a more costly inpatient basis when they should have been billed on a less costly outpatient basis.  The government has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations of overcharging Medicare for kyphoplasty procedures.  The 15 current settling hospitals include: The Cleveland Clinic (Ohio); Citrus Memorial Health System (Florida); Cullman Regional Medical Center (Alabama); Martin Memorial Medical Center (Florida); MultiCare Tacoma General Hospital (Washington); Norwalk Hospital (Connecticut); Princeton Community Hospital Association (West Virginia); Sacred Heart Medical Center (Washington); Sarasota Memorial Hospital (Florida); Spartanburg Regional Health Services District Inc. (South Carolina); St. Cloud Hospital (Minnesota); Tampa General Hospital (Florida); 5 hospitals affiliated with Community Health Systems Inc. (Tennessee); 5 hospitals affiliated with Tenet Health Care Corporation (Texas); 5 hospitals formerly owned and operated by Health Management Associates (Florida); 3 hospitals affiliated with BayCare Health System (Florida); and 2 hospitals affiliated with Banner Health (Arizona).  In addition, the government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations the company caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.  All but 3 of the current settlements originated in a whistleblower lawsuit filed by Craig Patrick, a former Kyphon reimbursement manager, and Charles Bates, a former Kyphon sales manager for Kyphon.  They will receive a whistleblower award of roughly $4.75 million from the proceeds of the government’s recovery.  DOJ

September 9, 2015

Constantine Cannon attorney Jessica Moore was quoted in the San Jose Mercury News article, Saratoga: Owners of Bay Sleep Clinic accused of defrauding Medicare. Click here to read the article.

July 27, 2015

A group of scammers who falsely promised consumers new Medicare cards in order to obtain their bank account numbers and debit their accounts will be banned from selling healthcare-related products and services under FTC settlements. The settlements resolve charges the FTC filed last year against Benjamin Todd Workman and Glenn Erikson and their companies. Their telemarketers falsely told consumers they needed their bank account numbers to verify their identities before sending a new Medicare card, promising they would not take money from the accounts. In fact, they took several hundred dollars from each consumer’s account and provided nothing in return. In some cases, their telemarketers falsely promised to provide consumers with identity theft protection services. FTC