Other Government Health Programs

November 23, 2016

Georgia pain management physician Dr. Anthony Clavo agreed to the entry of a consent judgment for $430,000 to resolve allegations he violated the False Claims Act by billing Medicare, Medicaid, and TRICARE for medically unnecessary services.  The allegations originated in a whistleblower lawsuit filed by Herretta Pickens and Teresa Williams, former employees of Dr. Clavo, under the qui tam provisions of the False Claims Act.  They will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery.  DOJ (NDGA)

October 24, 2016

Life Care Centers of America Inc., the Tennessee-based operator of more than 220 skilled nursing facilities, and its owner Forrest L. Preston, agreed to pay $145 million to resolve charges that Life Care violated the False Claims Act by submitting claims to Medicare and TRICARE for rehabilitation therapy services that were not reasonable, necessary or skilled.  It is the largest settlement with a skilled nursing facility chain in DOJ’s history.  The allegations originated in a whistleblower lawsuit filed by former Life Care employees Tammie Taylor and Glenda Martin under the qui tam provisions of the False Claims Act.  They will receive a whistleblower award of $29 million from the proceeds of the government’s recovery.  Whistleblower Insider

September 14, 2016

Healthmark Investment Trust, partial owner of Florida-based compound pharmacy QMedRx, agreed to pay $7.75 million to resolve allegations QMedRx violated the False Claims Act by billing the federal healthcare programs for prescriptions tainted within the meaning of the Anti-Kickback Statute.  The government is still pursuing penalties and fines from other owners and participants within QMedRx.  DOJ (MDFL)

June 30, 2016

The University of Missouri-Columbia agreed to pay $2.2 million to settle allegations that it violated the False Claims Act by submitting false claims for radiology services to federal programs such as Medicare, Medicaid, and TRICARE.  Specifically, the government alleged that certain attending physicians certified that they had reviewed the images associated with interpretative reports prepared by resident physicians when, in fact, they had not reviewed those images.  DOJ (WDMO)

June 13, 2016

Oklahoma-based FedCare, LLC and its related entity The Broadway Clinic of Tulsa, LLC, agreed to pay $2.5 million to settle charges of violating the False Claims Act by submitting false claims to the Office of Workers Compensation Programs of the Department of Labor.  According to the government, FedCare and Broadway submitted claims for medical services furnished to federal employees of fourteen federal agencies that were false because they were either (1) billed at a higher rate than allowed or (2) not performed at all.  DOJ (WDOK)

March 23, 2016

Pennsylvania-based Respironics Inc. agreed to pay $34.8 million to resolve charges it violated the False Claims Act and Anti-Kickback Statute by paying kickbacks in the form of free call center services to durable medical equipment (DME) suppliers that bought its masks for patients with sleep apnea.  Respironics allegedly provided DME companies with call center services to meet their patients’ resupply needs at no charge as long as the patients were using masks that Respironics manufactured; otherwise, the DME companies would have to pay a monthly fee based on the number of patients who used masks manufactured by a competitor of Respironics.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Gibran Ameer, who has worked for different DME companies.  He will receive a whistleblower award of $5.38 million from the proceeds of the government's recovery.  DOJ

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)