Other Government Health Programs Archives - Page 13 of 18

September 26, 2018

Health Management Associates, LLC (HMA)—now part of Community Health Systems Inc. (CHS)—has agreed to pay a combined $260 million to settle civil and criminal charges of defrauding Medicare, Medicaid, and TRICARE and violating the Anti-Kickback Statute, the Stark Law, and False Claims Act. The alleged fraud was revealed by eight whistleblowers and involved paying kickbacks to doctors for patient referrals, pressuring doctors to meet emergency patient admission quotas, billing outpatient or observational services as inpatient services, and inflating the cost of emergency services. The eight whistleblowers have been granted a combined $27 million award so far. DOJ; USAO EDPA; USAO SDFL; USAO WDNC

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Other Government Health Programs, Whistleblower Rewards,

September 19, 2018

Calloway Laboratories, Inc.—a Massachusetts-based clinical laboratory—has been ordered to pay a civil judgment of $1,374,058 to settle claims first brought to light by a former employee in a whistleblower lawsuit. The laboratory allegedly violated the Anti-Kickback Statute, Stark Law, and False Claims Act over the course of six months by providing free testing supplies to doctors in exchange for referrals and then submitting reimbursement claims for testing arising from these improper referrals to Medicare and TRICARE. USAO EDKY

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Other Government Health Programs, Whistleblower Case,

September 17, 2018

In the largest healthcare fraud case ever to come out of Mississippi, the co-owner of two Mississippi-based compounding pharmacies, Marco Bisa Hawkins Moran, has pleaded guilty to defrauding TRICARE of more than $22 million. As part of the fraud, Moran and others allegedly paid kickbacks to doctors and marketers to prescribe drugs for beneficiaries covered by TRICARE and other lucrative health benefit programs. Additionally, they allegedly selected formulas meant to maximize profits instead of benefit individuals, and submitted fraudulent reimbursement claims to TRICARE. The case spanned multiple states across the country, including California, Tennessee, Arkansas, and Connecticut, with twelve people charged and nine convicted so far. USAO SDMS

Tagged in: Compounding Pharmacy Fraud, Other Government Health Programs, Pharma Fraud,

August 10, 2018

Trinity Medical Pharmacy, LLP and several members of its leadership have agreed to pay $2,244,270.14 to settle allegations that it violated the False Claims Act by giving illegal kickbacks to patients and providers, billing TRICARE and other government programs for medical reimbursement claims arising from those kickbacks, and failing to disclose information that would have barred it from becoming a provider for Express Scripts, which provides pharmaceutical services for TRICARE. USAO MDFL

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Other Government Health Programs, Pharma Fraud,

August 1, 2018

Early Autism Project, Inc. (“EAP”) agreed to pay the United States $8,833,615 to settle allegations brought by whistleblower and former employee of EAP, Olivia Zeigler, that it submitted false claims to TRICARE (a military insurance program) and South Carolina’s Medicaid program for therapy services for children with autism. The therapy services were misrepresented or were never provided. EAP allegedly also created a program under which it billed Medicaid for functions that were not related to therapy services at all and permitted its therapists to regularly bill for more hours than they actually provided therapy services. Olivia Zeigler will be awarded $435,000. DOJ

Tagged in: FCA Federal, FCA State, Medicaid, Medical Billing Fraud, Other Government Health Programs, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

June 15, 2018

Susan K. Perry, a Mississippi-based nurse practitioner, pleaded guilty to participating in a scheme to defraud the government health care program TRICARE by signing prescriptions for medically unnecessary compounded medications for which TRICARE paid Advantage Pharmacy. TRICARE serves U.S. military personnel, veterans, and their family members. DOJ

Tagged in: Compounding Pharmacy Fraud, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

June 7, 2018

Mississippi physician Albert Diaz was sentenced to 42 months in prison for prescribing medically unnecessary compounded medications to TRICARE patients he had not examined and falsifying medical records to make it appear he had treated the patients. The fraud cost TRICARE and other insurers more than $3 million. DOJ

Tagged in: Compounding Pharmacy Fraud, Other Government Health Programs, Provider Fraud,

April 5, 2018

The Estate of Dr. Leroy Pelicci, former owner of Scranton-based Pelicci Pain Relief Center, agreed to pay $625,000 to settle claims he violated the False Claims Act by submitting improper claims for payment to the Department of Labor Office of Workers’ Compensation Programs under the Federal Employees Compensation Act and the Federal Employees Health Benefits Program for trigger point injections, which were upcoded to receive a higher reimbursement amount than permitted. DOJ (MDPA)

Tagged in: Healthcare Fraud, Other Government Health Programs, Provider Fraud, Upcoding,

March 30, 2018

Larry B. Howard, the owner of an Orlando-based Fertility Pharmacy, was sentenced to serve 160 months in prison and forfeit over $4.3 million for his role in a kickback scheme involving pain and scar creams that resulted in the payment of approximately $4.3 million in false and fraudulent claims to TRICARE. DOJ

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Other Government Health Programs,

January 23, 2018

California medical device company DJO Global Inc. agreed to pay $7.62 million to resolve allegations that its Minnesota subsidiary Empi Inc. submitted false claims to TRICARE for excessive, unnecessary transcutaneous electrical nerve stimulation electrodes that TRICARE beneficiaries did not need or use. TENS is a therapy that uses low-voltage electrical current for pain relief. DOJ

Tagged in: Lack of Medical Necessity, Medical Devices and DME, Other Government Health Programs,

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