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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:

Page 10 of 11

February 11, 2016

Compounding pharmacies WELLHealth and Topical Specialists and four physicians, Manish Bansal, Mehul Parekh, Marisol Arcila, and Syed Asad, agreed to pay approximately $10 million to resolve allegations they violated the False Claims Act by submitting false claims to TRICARE, the military’s healthcare program.  According to the government, the physicians wrote hundreds of prescriptions for pain and scar creams never used by patients and billed to the government at a cost which yielded up to 90% in profits.  Bansal is a cardiologist at Baptist Hospital; Arcila is a pain management physician at Premier Spine & Pain Center; Asad is a neurologist at Universal Neurological Care; Parekh is a general practice physician at Baptist Hospital.  DOJ (M.D.Fla)

November 25, 2015

The US settled for more than $30 million allegations against several Florida compound pharmacies and their owners for violating the False Claims Act by fraudulently billing TRICARE, the military’s healthcare program.  The settling defendants and their respective settlements include: MedMatch Pharmacy (agreeing to pay more than $4.7 million to resolve concerns that it paid kickbacks to marketers, that it filled prescriptions it knew or should have known were not legitimate, and that it sent prescriptions to states in which it did not have a valid license); OHM Pharmacy (agreeing to pay $4.1 million to resolve allegations of filling prescriptions from a doctor who was writing them outside the ordinary course of practice); WELL Health Pharmacy and its owner (agreeing to pay more than $3 million, as well as 50% of its net profits for five years, for filling prescriptions written by referral sources that had a financial interest in the prescriptions); Topical Specialists (agreeing to pay more than $2.2 million for submitting prescriptions that were tainted by so-called “research fees,” which was an elaborate guise for paying physicians to write prescriptions); Durbin Pharmacy (agreeing to pay $2.1 million, plus 50% of its net profits for five years, for submitting prescriptions that were tainted by kickbacks); and North Beaches Pharmacy (agreeing to pay $10,000, plus 50% of its net profits for five years, for filling compound prescriptions that the government contends were tainted by illegal kickbacks).  DOJ (MDFL)

July 24, 2015

California oncologist Dr. Neelesh Bangalore has paid $736,000 to settle allegations that he improperly billed Medicare, Medicaid, and Tricare for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical distributor, Warwick Healthcare Solutions Inc., also known as Richards Pharma, a former United Kingdom-based drug distributer that did not have a license to distribute drugs in the United States.  DOJ

June 26, 2015

Charlie Chi, the former president and CEO of OtisMed Corporation, was sentenced to two years in prison and to pay a $75,000 fine for intentionally distributing a medical device used in knee replacement surgery after its application for marketing clearance had been rejected by the Food and Drug Administration.  In September 2014, OtisMed, now a subsidiary of Stryker Corporation, was sentenced to a criminal fine of $34.4 million and ordered to pay $5.16 million in criminal forfeiture for this conduct.  In a related civil settlement, OtisMed agreed to pay approximately $41.2 million to resolve its civil liability for submitting false claims to the Medicare, TRICARE, Federal Employees Health Benefits and Medicaid programs.  DOJ

June 18, 2015

Non-profit hospice care provider Covenant Hospice Inc. agreed to pay $10,149,374 to reimburse the government for alleged overbilling of Medicare, Tricare and Medicaid for hospice services.  According to the government, Covenant Hospice improperly submitted hospice claims for general inpatient care that should have been billed at the routine home care level.  The government further alleged that Covenant Hospice’s medical records did not support the medical necessity of the general inpatient care.  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

March 19, 2014

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $5,412,502 to resolve claims it violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons.  The allegations arose in a whistleblower lawsuit filed by Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A., under the qui tam provisions of the False Claims Act.  Dr. Montejo will receive a whistleblower award of $1,082,500.  DOJ

February 24, 2015

Louisiana oncologist Prabhjit S. Purewal agreed to pay $550,000 to settle allegations he defrauded Medicare, Tricare and Medicaid in violation of the False Claims Act by billing for chemotherapy drugs not approved by the FDA.  Dr. Purewal purchased the drugs from UK-based drug distributor Warwick Healthcare Solutions, Inc. (also known as Richard’s Pharma), which did not have a license to distribute drugs in the US.  DOJ

October 30, 2014

San Francisco based hospital system Dignity Health (formerly known as Catholic Healthcare West) agreed to pay $37M to settle False Claim Act charges that 13 of its hospitals in California, Nevada and Arizona submitted false claims to Medicare and TRICARE by admitting patients for inpatient services who could have been treated on a less costly, outpatient basis. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Kathleen Hawkins, a former employee of Dignity. She will receive a whistleblower award of $6.25M. DOJ

August 4, 2014

Community Health Systems (CHS), the nation’s largest operator of acute care hospitals, agreed to pay $98 million to resolve multiple whistleblower lawsuits alleging the company billed government health care programs for inpatient services that should have been billed as outpatient or observation services. According to the government, CHS engaged in a corporate-driven scheme to increase inpatient admissions of Medicare, Medicaid and TRICARE (military) beneficiaries over the age of 65 who originally presented to the emergency departments at 119 CHS hospitals.Whistleblower Insider
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