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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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June 7, 2017

Texas-based medical and physical therapy provider Union Treatment Center agreed to pay $3 million to settle charges it violated the False Claims Act by defrauding the federal workers’ compensation (FECA) program.  The company will also waive claims for payment exceeding $1.6 million and be permanently excluded from participating in federal health care programs.  According to the government, UTC fraudulently billed the FECA program for services it did not render, routinely overcharged for medical examinations, falsely inflated the time patients spent in therapy, billed for unnecessary services and supplies, and paid kickbacks in exchange for patient referrals.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. DOJ (WDTX)

June 5, 2017

Texas-based Integrated Medical Solutions Inc. and the company’s former president Jerry Heftler agreed to pay roughly $2.5 million to settle allegations they violated the False Claims Act and Anti-Kickback Act in connection with the U.S. Bureau of Prisons. DOJ

April 25, 2017

Braden Partners, L.P. (d/b/a Pacific Pulmonary Services) agreed to pay $11.4 million to resolve allegations against it and its general partner, Teijin Pharma USA LLC, for violating the False Claims Act by submitting claims for reimbursement to Medicare and other federal healthcare programs for oxygen and related equipment supplied in violation of program rules, and for sleep therapy equipment supplied as part of a cross-referral kickback scheme with sleep clinics. According to the government, Pacific Pulmonary submitted claims to the Medicare, TRICARE and Federal Employee Health Benefits programs for home oxygen and oxygen equipment without obtaining the required physician authorization. The government further charged that certain of the company’s patient care coordinators agreed to make patient referrals to sleep testing clinics in exchange for those clinics’ agreement to refer patients to Pacific Pulmonary for sleep therapy equipment in violation of the Anti-Kickback Act. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Manuel Alcaine, a former sales representative of Pacific Pulmonary. Mr. Alcaine will receive a whistleblower award of roughly $1.8 million from the proceeds of the government's recovery. DOJ

March 31, 2017

Tennessee based Exemplary Behavior, LLC and its principal, Andre Anderson, agreed to pay $20,000 to settle allegations they violated the False Claims Act by submitting false claims for payment to the Defense Health Agency’s TRICARE program for the provision of therapy services, including Applied Behavior Analysis (“ABA”) to children with Autism Spectrum Disorder (“ASD”).  Specifically, the settlement resolves charges that Exemplary Behavior submitted false claims to TRICARE as a result of their (1) double billing for services rendered; (2) billing for services not rendered by the billing provider; (3) providing group therapy while billing for individual therapy; and (4) billing for services, including ABA therapy, that were not actually provided. DOJ (MDTN)

February 6, 2017

U.S. hospital service provider TeamHealth Holdings (as successor in interest to IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc.), agreed to pay $60 million to resolve allegations it violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed (a practice known as “up-coding”).  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist.  He will receive a whistleblower award of roughly $11.4 million.  DOJ

Kentucky Pain Management Physician Pays $20M to Settle FCA Charges

Posted  02/2/17
By the C|C Whistleblower Lawyer Team Dr. Robert Windsor, the owner of several Kentucky and Georgia pain management clinics operating under the umbrella of National Pain Care, Inc., agreed to a $20 million consent judgment resolving government allegations he billed federal health care programs for surgical monitoring services he did not perform, and for medically unnecessary diagnostic tests. To satisfy the...

Top-10 False Claims Act Kickback Recoveries For 2016

Posted  01/4/17
By the C|C Whistleblower Lawyer Team Here is our look-back at the top-10 Department of Justice False Claims Act recoveries in 2016 for violations of the Anti-Kickback Statute and/or the Stark Law.  Click here for a full chronological listing of all the DOJ False Claims Act recoveries in 2016.
  1. Lexington Medical Center -- The South Carolina hospital agreed to pay $17 million to resolve allegations it violated...

Top-10 DOJ False Claims Act Recoveries For 2016

Posted  01/3/17
By the C|C Whistleblower Lawyer Team Here is our look-back at the top-10 Department of Justice False Claims Act recoveries for 2016. 10. Vibra Healthcare -- The Pennsylvania-based hospital chain agreed to pay $32.7 million to resolve claims it violated the False Claims Act by billing Medicare for medically unnecessary services by admitting patients to its long term care hospitals and rehab facilities who did not...

Top-10 Whistleblower Successes for 2016

Posted  01/3/17
By the C|C Whistleblower Lawyer Team Here is our look-back at the top-10 whistleblower award recoveries for 2016. 10. Harry Markopolos -- Famed Bernie Madoff whistleblower Harry Markopolos made a filing under the whistleblower provisions of the Financial Institutions Reform, Recovery and Enforcement Act (FIRREA) which led to the agreement by Massachusetts-based State Street Bank and Trust Company to pay a total...
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