Medicare
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March 30, 2023
Pharmacist Gisele Nguyen will pay over $3.9 million for fraudulently billing Medicare for medications that were never dispensed. For at least a 5-year period, from 2014 to 2018, Nguyen, dba Natico Pharmacy, submitted fraudulent claims for prescriptions that were never dispensed, and inventory records reflected that the pharmacy did not purchase enough of the medications from wholesalers to meet the fraudulent demand. DOJMarch 29, 2023
Michigan-based Covenant Healthcare System and two physicians, neurosurgeon Dr. Mark Adams and electrophysiologist Dr. Asim Yunus, have agreed to pay $69 million and about $406,500 and $346,000 respectively to resolve allegations of violating the Anti-Kickback Statute, Stark Law, and False Claims Act. Covenant allegedly provided Dr. Yunus and five other physicians medical directorship roles, employed Dr. Adams, forgave rent payments from another physician, and permitted a physician group to secure a lease on advantageous terms in exchange for referrals. Covenant then submitted false claims based on those referrals to Medicare, Medicaid, and TRICARE. The claims were first raised by Dr. Stacy Goldsholl in a qui tam suit; Goldsholl will receive over $12 million from the three settlements. USAO EDMIAs States Look to Expand Health Coverage, State FCAs Become More Important than Ever
Posted 03/22/23
March 20, 2023
Acute care hospital Luminis Health Doctors Community Medical Center, Inc. (“DCMC”) and radiology imaging practice Diagnostic Imaging Associates, LLC (“DIA”) have agreed to pay $2 million to resolve allegations of defrauding federal healthcare programs. Because DCMC’s outpatient cancer screening facility was not enrolled in Medicare and Medicaid and was thus not eligible for reimbursements, it entered into a written agreement with DIA whereby DIA would bill the programs for services performed by DIA as well as DCMC’s outpatient cancer screening facility, in violation of program rules and the False Claims Act. The alleged misconduct occurred between 2010 and 2020. USAO MDMarch 17, 2023
A man in New York who laundered millions of dollars of criminal proceeds from a panoply of illegal schemes—including computer hacking, healthcare fraud, loan fraud involving Small Business Administration (SBA) funds, and operating an unlicensed international money transmitting business—has been sentenced to 10 years in prison. According to the DOJ, Djonibek Rahmankulov worked with computer hackers to gain control of U.S. bank accounts, then executed millions of dollars of fraudulent wire transfers into accounts controlled by him and his associates. He also worked with pharmacies to launder millions of dollars of Medicare and Medicaid reimbursements for HIV medications that were not actually dispensed or legally obtained. During the pandemic, Rahmankulov submitted fraudulent applications to the SBA for his companies, laundered the proceeds, and made false statements to financial institutions regarding his activities. Finally during his trial, he repeatedly sought to obstruct justice by threatening a witness and producing fraudulent letters of support from the community. USAO SDNYHealthcare Fraud Jury Verdict Demonstrates DOJ’s Commitment to Prosecuting Kickbacks
Posted 03/13/23
