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Other Government Health Programs

This archive displays posts tagged as relevant to government healthcare programs other than Medicare and Medicaid, and fraud in those programs. You may also be interested in our pages:

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October 2, 2020

Two New York-based physical therapy providers have agreed to pay $4 million to resolve whistleblower-brought allegations of violating the False Claims Act by improperly billing multiple government healthcare programs, including Medicare, Medicaid, the Federal Employees’ Compensation Act Program (FECA), and the Federal Employees’ Health Benefits Program (FEHBP).  The alleged misconduct by Williamsburg Physical Therapy, P.C., Euro Physical Therapy, P.C., owners Alex and Diana Klurfeld, and management company First Plus Services, Inc. occurred between 2008 to 2018, and involved billing for physical therapy services provided or supervised by someone other than the licensed therapist listed on claims, as well as backdating services after treatment authorizations had expired.  USAO EDNY

August 24, 2020

Following a whistleblower suit by a former sales representative, DUSA Pharmaceuticals (DUSA), a Massachusetts-based subsidiary of Sun Pharmaceuticals Industries Inc. (Sun Pharma), has agreed to pay $20.75 million to resolve allegations of defrauding Medicare and the Federal Employee Health Benefit Pr­­­ogram.  According to relator Aaron Chung, senior management at DUSA and Sun Pharma allegedly encouraged doctors, via paid speaker programs and discussions, to use shorter incubation periods of 1-3 hours for Levulan Kerastick, a topical prescription medication for treating actinic keratosis (AK) of the face and scalp that had FDA-approved instructions for 14-18 hour incubation periods.  As expected, the significantly reduced incubation periods resulted in significantly reduced AK clearance rates, yet DUSA failed to inform doctors of the lower rates and even actively misinformed them that AK clearance rates were the same regardless of incubation period.  For exposing the fraudulent conduct, Chung will receive approximately $3.5 million of the settlement proceeds.  DOJ; USAO WDWA

July 23, 2020

Two pharmacists who were co-owners of Advantage Pharmacy in Mississippi have been sentenced to over 12 years in prison each and ordered to pay between $9 million and $29 million in civil monetary judgment, and between $185 million and $189 million in restitution for committing healthcare fraud.  According to the press release, Glenn Doyle Beach and Hope Thomley marketed, dispensed, and distributed compounded medications without regard to medical necessity, causing various health benefit programs, including TRICARE, to pay over $200 million in reimbursements.  Thomley’s husband, Randy Thomley, has been sentenced to 8 years in prison and ordered to pay judgment and restitution of $3.6 million each for his role in helping to recruit TRICARE beneficiaries.  USAO SDMS

July 23, 2020

Progenity, Inc., f/k/a Ascendant MDx, Inc., has agreed to pay a total of $49 million to resolve allegations that the California-based clinical laboratory submitted false claims to Medicaid, the VA, TRICARE, and the Federal Employees Health Benefits Program (FEHBP) through different fraudulent schemes.  First, from 2012 to 2016, Progenity allegedly billed the programs for non-reimbursable prenatal tests using a reimbursable billing code.  Second, in claims originally brought by a whistleblower under the False Claims Act, the company was alleged to violate the Anti-Kickback Statue by providing improper incentives to physicians—including paying above fair market value for blood specimen “draw fees”, providing tens of thousands of dollars in free food and alcohol, and routinely reducing or waiving co-insurance or deductibles—in order to induce physicians to order their tests.  Approximately $35.9 million of the settlement proceeds will go toward resolving federal claims, with the remaining $13.1 million paid to different states.  AG NC; USAO SDCA; USAO SDNY

July 10, 2020

Universal Health Services, Inc. and UHS of Delaware, Inc. (collectively, UHS), and a Georgia-based UHS facility, Turning Point Care Center, LLC, have agreed to pay a combined $122 million to settle 18 qui tam cases pending in four jurisdictions.  In violation of the False Claims Act, UHS allegedly billed federal healthcare programs—including Medicare, Medicaid, TRICARE, the Department of Veteran Affairs, and the Federal Employee Health Benefit programs—for medically unnecessary inpatient behavioral health services, failed to provide adequate or appropriate services, and paid illegal inducements to beneficiaries of those programs.  UHS will pay over $88 million to the federal government and nearly $29 million to individual states, for a combined penalty of $117 million, with a relator share of about $15.8 million.  Turning Point will pay $5 million to the federal government and the State of Georgia; the whistleblower in that case will receive $861,853.64.  USAO MDFL; USAO NDGA; USAO EDPA; AG FL; AG MI; AG NC; AG VA

July 8, 2020

A Florida-based nonprofit that provides hospice care, palliative care, and other services to the elderly, has agreed to pay $3.2 million to resolve its liability under the False Claims Act.  According to former Director of Hospice Care, Margaret Peters, Hope Hospice knowingly submitted false claims to Medicare, Medicaid, and TRICARE for medically unnecessary but highly reimbursed general inpatient (GIP) hospice services over a five year period.  For blowing the whistle on the alleged fraud, Peters will receive a 19% share of the settlement.  USAO MDFL

July 8, 2020

An orthopedic hospital, its management company, a physician’s group, and two physicians have agreed to pay $72.3 million to resolve whistleblower-brought allegations under the Anti-Kickback Statute, federal False Claims Act, and Oklahoma Medicaid False Claims Act of defrauding Medicare, Medicaid, and TRICARE.  Between 2006 and 2018, the Oklahoma Center for Orthopaedic and Multi-Specialty Surgery (OCOM) and its part-owner and management company, USP OKC, Inc. and USP OKC Manager, Inc. (collectively USP), allegedly provided free or below-fair market rate services and compensation to Southwest Orthopaedic Specialists, PLLC (SOS), including SOS physicians Anthony Cruse, D.O., and R.J. Langerman, Jr., D.O., in exchange for patient referrals.  USP also allegedly offered preferential investment opportunities to physicians in Texas.  As part of the settlement, USP will pay $60.86 million to the United States, $5 million to the State of Oklahoma, and $206,000 to the State of Texas, while SOS and its physician defendants will pay $5.7 million to the United States and $495,619 to the State of Oklahoma.  DOJ

July 7, 2020

Florida Cancer Specialists & Research Institute, LLC (FCS) has agreed to return more than $2.3 million in overcharges to the VA after a successful qui tam action by a former Claims Resolution Specialist with FCS, Marianne Parker.  Parker’s complaint instigated a government investigation that found that an error in the VA’s billing system had led the agency to pay the full amount billed by FCS for certain physician-administered drugs provided to veterans, rather than at the Medicare rate mandated by the Code of Federal Regulations.  For alerting the government to the discrepancies, Parker will receive a 20% share of the funds.  USAO MDFL

June 25, 2020

George Philip Tompkins of Houston, Texas, the former owner of Piney Point Pharmacy, was sentenced to ten years in prison following his conviction on charges of healthcare fraud, unlawful kickbacks, money laundering, and wire fraud.  Tompkins billed $21.8 million to federal and state worker’s compensation programs for medically unnecessary compound gels and creams, paying kickbacks to generate prescriptions while claiming that the kickbacks were legitimate marketing expenses. Thompson was also ordered to pay restitution of $12.3 million. DOJ

June 16, 2020

A doctor in Mississippi has been sentenced to four years in prison and ordered to pay nearly $5 million in restitution and judgment for committing healthcare fraud against multiple insurers, including TRICARE.  In exchange for a 35% cut of reimbursements, Dr. Shahjahan Sultan had agreed to enter into a contract with a local pharmacy to prescribe expensive compound medications to insured patients, which he did without regard to medical necessity, and which resulted in over $8 million in losses to insurers.  USAO SDMS
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